[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-206315-105":59,"doc-detail-206315-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","subclinical-atrial-fibrillation-who-benefits-from-oral-anticoagulation","Subclinical atrial fibrillation: Who benefits from oral anticoagulation?","","Anticoagulation for preventing embolic stroke in subclinical atrial fibrillation detected by implantable cardiac devices has not been established. Two randomized trials—NOAH-AFNET-6 and ARTESiA—reached differing conclusions due to different primary endpoints. The central question is the extent to which anticoagulation reduces stroke and thromboembolism while balancing the risk of major bleeding. A meta-analysis integrating key endpoints showed overall anticoagulation superiority, mainly in higher-risk patients (CHA2DS2-VASc >4) and not indicated when CHA2DS2-VASc \u003C4.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/subclinical-atrial-fibrillation-who-benefits-from-oral-anticoagulation/206315/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/subclinical-atrial-fibrillation-who-benefits-from-oral-anticoagulation/206315.png","ImageObject",300,407,{"name":92,"@type":93},"Dipper","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-05",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is anticoagulation benefit uncertain in subclinical atrial fibrillation detected by devices?","Question",{"text":113,"@type":114},"The value of anticoagulation for preventing embolic stroke in device-detected subclinical AF has not been established, and patients often have both high stroke risk and increased bleeding risk. Careful risk–benefit analysis is needed before starting therapy.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What are the main differences between NOAH-AFNET-6 and ARTESiA results?",{"text":118,"@type":114},"NOAH-AFNET-6 concluded that no device-detected AF patients should be anticoagulated based on a composite primary endpoint. ARTESiA showed overall anticoagulation value using stroke/systemic embolism as the sole primary endpoint, leading to different conclusions.",{"name":120,"@type":111,"acceptedAnswer":121},"Who benefits most from oral anticoagulation according to the meta-analysis?",{"text":122,"@type":114},"Combined evidence and meta-analysis suggest superiority of anticoagulation mainly in higher-risk patients, particularly those with CHA2DS2-VASc score >4 and especially with any type of vascular disease. No anticoagulation is indicated when CHA2DS2-VASc score \u003C4, with shared decision-making recommended when it equals 4.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},206315,1788591516,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":130,"read_time":144},1374404997633,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","􀂄 REVIE W  \nSubclinical atrial fibrillation: Who benefits from oral anticoagulation?  \nDan Atar1, 2, Cecilia Linde3, 4  \n1Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway 2Institute of Clinical Sciences, University of Oslo, Oslo, Norway  \n3Heart, Vascular and Neurology Theme, Karolinska University Hospital, Stockholm, Sweden 4Division of Cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden  \nCorrespondence to:  \nProf. Dan Atar, MD, FESC, FACC, FAHA,  \nDepartment of Cardiology, Oslo University Hospital Ulleval, N–0450 Oslo, Norway,  \nphone: +47 22 11 91 87, [e-mail: danat@uio.no](e-mail: danat@uio.no)[ ](e-mail: danat@uio.no)Copyright by the Author(s), 2025 DOI: 10.33963/v.phj.106733  \nReceived:  \nMay 20, 2025  \nAccepted:  \nJune 11, 2025  \nEarly publication date:  \nJune 11, 2025  \nA B S T R A C T  \nThe value of anticoagulation to prevent embolic stroke in subclinical atrial fibrillation detected by implantable cardiac devices has not been established. Recently, two randomized controlled studies scrutinized whether such patients benefit from oral anticoagulation to prevent embolic strokes. These two studies were the NOAH-AFNET-6 (anticoagulation with edoxaban in patients with atrial highrate episodes) trial and the ARTESiA (Apixaban for stroke prevention in subclinical atrial fibrillation) study, but they came to different conclusions using different primary endpoints. While the investigators of NOAH-AFNET-6, based on a composite primary endpoint, concluded that no patient with device-detected AF should be anticoagulated, the ARTESiA investigators demonstrated the overall value of anticoagulation based on stroke/systemic embolism asthe sole endpoint. However, the main question for subclinical atrial fibrillation patients is to which extent stroke and thromboembolism can be prevented by anticoagulation and weighing such a benefit to the risk of major bleeding. After initial confusion a meta-analysis of both studies focusing on the endpoints “ischemic stroke”and “all-cause stroke” showed an overall superiority of anticoagulation against placebo/aspirin therapy. The combined evidence demonstrated to the cardiovascular community the superiority of anticoagulation but confined to those with high risk, i.e., CHA2DS2-VASc score >4, particularly in those with any type of vascular disease. The meta-analysis also showed that no anticoagulation is indicated in patients with CHA2DS2-VASc score \u003C4, and with shared decision-making recommended for those with CHA2DS2-VASc score of 4. It is reassuring that despite the first impression of diverging results in the two major trials, a meta-analysis helped to clarify the uniformity and consistency of the results across the studies, which will help physicians and nurses in their daily care of patients with implantable devices.  \nKey words: AF, anticoagulants, defibrillator, pacemaker, stroke  \nINTRODUCTION  \nIn device clinics the presence of atrial fibrillation (AF) in the absence of symptoms is well known, but its prevalence, implication for stroke risk and whether such patients need oral anticoagulation has not been fully explored. Device-detected AF is associated with an increased risk of ischemic stroke, but this risk is smaller than in patients with clinical AF verified by surface electrocardiogram. In addition, patients with implanted devices are often elderly and have a high burden of stroke risk factors but are also at increased risk for bleeding events. This is the reason why the  \nrisk/benefit of oral anticoagulation needs careful analysis before therapy initiation. The term subclinical AF (SCAF) has been used in these circumstances and encompasses the alternative wording of “atrial high-rate episodes” (AHRE), or device detected AF, which in some instances, depending on technology, can be verified by electrogram recordings.“Subclinical” indicates that patients do not typically sense these episodes, i.e., they are only captured by the fact that ","cbCaivmrWDZc7nJq","https://ap.wps.com/l/cbCaivmrWDZc7nJq","pdf",147208,"English","# Abstract\n# Introduction\n## Device-detected AF and subclinical AF terminology\n## Clinical implications and risk/benefit considerations\n# Table 1: Key characteristics of the two trials","[{\"question\":\"Why is anticoagulation benefit uncertain in subclinical atrial fibrillation detected by devices?\",\"answer\":\"The value of anticoagulation for preventing embolic stroke in device-detected subclinical AF has not been established, and patients often have both high stroke risk and increased bleeding risk. Careful risk–benefit analysis is needed before starting therapy.\"},{\"question\":\"What are the main differences between NOAH-AFNET-6 and ARTESiA results?\",\"answer\":\"NOAH-AFNET-6 concluded that no device-detected AF patients should be anticoagulated based on a composite primary endpoint. ARTESiA showed overall anticoagulation value using stroke/systemic embolism as the sole primary endpoint, leading to different conclusions.\"},{\"question\":\"Who benefits most from oral anticoagulation according to the meta-analysis?\",\"answer\":\"Combined evidence and meta-analysis suggest superiority of anticoagulation mainly in higher-risk patients, particularly those with CHA2DS2-VASc score \\u003e4 and especially with any type of vascular disease. No anticoagulation is indicated when CHA2DS2-VASc score \\u003c4, with shared decision-making recommended when it equals 4.\"}]","Subclinical atrial fibrillation: Who benefits from oral anticoagulation? | PDF",15]