Anticoagulation in Patients With Device-Detected Atrial Fibrillation With and Without a Prior Stroke or Transient Ischemic Attack: dThe NOAH-AFNET 6 Trial

被引：13

作者：

Diener, Hans Christoph ^{[1
]}

Becher, Nina ^{[2
,3
]}

Sehner, Susanne ^{[4
]}

Toennis, Tobias ^{[2
,3
]}

Bertaglia, Emanuele ^{[5
]}

Blomstrom-Lundqvist, Carina ^{[6
,7
]}

Brandes, Axel ^{[8
,9
]}

Beuger, Vincent ^{[9
]}

Calvert, Melanie ^{[10
,11
,12
]}

Camm, A. John ^{[13
]}

Chlouverakis, Gregory ^{[14
]}

Dan, Gheorghe-Andrei ^{[15
]}

Dichtl, Wolfgang ^{[16
]}

Fierenz, Alexander ^{[4
]}

Goette, Andreas ^{[9
,17
,18
]}

de Groot, Joris R. ^{[19
]}

Hermans, Astrid ^{[20
]}

Lip, Gregory Y. H. ^{[21
,22
,23
]}

Lubinski, Andrzej ^{[24
]}

Marijon, Eloi ^{[25
]}

Merkely, Bela ^{[26
]}

Mont, Lluis ^{[27
,28
,29
]}

Nikorowitsch, Julius ^{[2
,3
]}

Ozga, Ann-Kathrin ^{[4
]}

Rajappan, Kim ^{[30
]}

Sarkozy, Andrea ^{[31
]}

Scherr, Daniel ^{[32
]}

Schnabel, Renate B. ^{[2
,3
,9
]}

Schotten, Ulrich ^{[9
,20
]}

Simantirakis, Emmanuel ^{[33
]}

Vardas, Panos ^{[33
,34
]}

Wichterle, Dan ^{[35
]}

Zapf, Antonia ^{[4
,9
]}

Kirchhof, Paulus ^{[2
,3
,9
]}

机构：

[1] Univ Duisburg Essen, Inst Med Informat Biometry & Epidemiol IMIBE, Dept Neuroepidemiol, Essen, Germany

[2] Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, Hamburg, Germany

[3] German Ctr Cardiovasc Res DZHK, Partner Site Hamburg Kiel Luebeck, Hamburg, Germany

[4] Univ Med Ctr Hamburg Eppendorf, Inst Med Biometry & Epidemiol, Hamburg, Germany

[5] Camposampiero Hosp AULSS Euganea, Cardiol Unit, Padua, Italy

[6] Uppsala Univ, Dept Med Sci, Uppsala, Sweden

[7] Orebro Univ, Fac Med & Hlth, Sch Med Sci, Dept Cardiol, Orebro, Sweden

[8] Univ Hosp Southern Denmark, Esbjerg Hosp, Dept Cardiol, Esbjerg, Denmark

[9] Atrial Fibrillat Network AFNET, Munster, Germany

[10] Univ Birmingham, Inst Appl Hlth Res, Ctr Patient Reported Outcomes Res, Birmingham, England

[11] Univ Birmingham, NIHR Birmingham Biomed Res Ctr, Birmingham, England

[12] Univ Birmingham, NIHR Appl Res Collaborat West Midlands, Birmingham, England

[13] St Georges Univ London, Cardiovasc & Cell Sci Res Inst, London, England

[14] Univ Crete, Sch Med, Biostat Lab, Iraklion, Greece

[15] Med Univ Carol Davila, Colentina Univ Hosp, Bucharest, Romania

[16] Innsbruck Med Univ, Dept Internal Med Cardiol & Angiol 3, Innsbruck, Austria

[17] St Vincenz Hosp Paderborn, Dept Cardiol & Intens Care Med, Paderborn, Germany

[18] Otto von Guericke Univ, Magdeburg, Germany

[19] Univ Amsterdam, Amsterdam Univ, Amsterdam Cardiovasc Sci, Heart Ctr,Dept Clin & Expt Cardiol,Med Ctr, Amsterdam, Netherlands

[20] Maastricht Univ, Dept Cardiol & Physiol, Maastricht, Netherlands

[21] Univ Liverpool, Liverpool John Moores Univ, Liverpool Ctr Cardiovasc Sci, Liverpool, England

[22] Liverpool Heart & Chest Hosp, Liverpool, England

[23] Aalborg Univ, Danish Ctr Hlth Serv Res, Dept Clin Med, Aalborg, Denmark

[24] Med Univ Gdansk, Dept Cardiol & Internal Dis, Gdansk, Poland

[25] Hop Europeen Georges Pompidou, Cardiol Div, Paris, France

[26] Semmelweis Univ, Heart & Vasc Ctr, Budapest, Hungary

[27] Univ Barcelona, Hosp Clin, Barcelona, Catalonia, Spain

[28] Inst Invest Biomed August Pi i Sunyer IDIBAPS, Barcelona, Catalonia, Spain

[29] Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain

[30] Oxford Univ Hosp NHS Fdn Trust, John Radcliffe Hosp, Cardiac Dept, Oxford, England

[31] Univ Hosp Brussels VUB, Dept Endocrinol, Brussels, Belgium

[32] Med Univ Graz, Dept Cardiol, Graz, Austria

[33] Heraklion Univ Hosp, Dept Cardiol, Iraklion, Greece

[34] Greece & Hygeia Hosp Grp, Biomed Res Fdn Acad Athens BRFAA, Athens, Greece

[35] Inst Clin & Expt Med, Prague, Czech Republic

来源：

JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2024年 / 13卷 / 17期

关键词：

anticoagulation; atrial fibrillation; CHA(2)DS(2)-VASc score; device-detected atrial fibrillation; NOAH-AFNET; 6; recurrent stroke; ORAL ANTICOAGULANTS; PREVENTION;

D O I：

10.1161/JAHA.124.036429

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Short and rare episodes of atrial fibrillation (AF) are commonly detected using implanted devices (device-detected AF) in patients with prior stroke or transient ischemic attack (TIA). The effectiveness and safety of oral anticoagulation in patients with prior stroke or TIA and device-detected AF but with no ECG-documented AF is unclear. Methods and Results: This prespecified analysis of the NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes) trial with post hoc elements assessed the effect of oral anticoagulation in patients with device-detected AF with and without a prior stroke or TIA in the randomized, double-blind, double-dummy NOAH-AFNET 6 trial. Outcomes were stroke, systemic embolism, and cardiovascular death (primary outcome) and major bleeding and death (safety outcome). A prior stroke or TIA was found in 253 patients with device-detected AF randomized in the NOAH-AFNET 6 (mean age, 78 years; 36.4% women). There was no treatment interaction with prior stroke or TIA for any of the primary and secondary time-to-event outcomes. In patients with a prior stroke or TIA, 14 out of 122 patients experienced a primary outcome event with anticoagulation (5.7% per patient-year). Without anticoagulation, there were 16 out of 131 patients with an event (6.3% per patient-year). The rate of stroke was lower than expected (anticoagulation: 4 out of 122 [1.6% per patient-year]; no anticoagulation: 6 out of 131 [2.3% per patient-year]). Numerically, there were more major bleeding events with anticoagulation in patients with prior stroke or TIA (8 out of 122 patients) than without anticoagulation (2 out of 131 patients). Conclusions: Anticoagulation appears to have ambiguous effects in patients with device-detected AF and a prior stroke or TIA in this hypothesis-generating analysis of the NOAH-AFNET 6 in the absence of ECG-documented AF, partially due to a low rate of stroke without anticoagulation.

引用

页数：13

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