{"id":"4e3f926f646e","type":"article","url":"https://hartvaat.nl/2024/07/23/artesia-apixaban-versus-aspirine-naar-cha2ds2-vasc-bij-subclinisch-af/","title":"ARTESIA: apixaban versus aspirine naar CHA₂DS₂-VASc bij subclinisch AF","title_en":"Apixaban vs Aspirin According to CHA2DS2-VASc Score in Subclinical Atrial Fibrillation: Insights From ARTESiA.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.05.002","source_url":"https://doi.org/10.1016/j.jacc.2024.05.002","authors":["Renato D Lopes","Christopher B Granger","Daniel M Wojdyla","William F McIntyre","Marco Alings","Thenmozhi Mani","Chinthanie Ramasundarahettige","Lena Rivard","Dan Atar","David H Birnie","Giuseppe Boriani","Guy Amit","Peter Leong-Sit","Claus Rinne","Gabor Z Duray","Michael R Gold","Stefan H Hohnloser","Valentina Kutyifa","Juan Benezet-Mazuecos","Jens Cosedis Nielsen","Christian Sticherling","Alexander P Benz","Cecilia Linde","Joseph Kautzner","Philippe Mabo","Georges H Mairesse","Stuart J Connolly","Jeff S Healey"],"significance":7,"published":"2024-07-23","source_date":"2024-07-23","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/","https://hartvaat.nl/kennis/atriumfibrilleren/wat-is-atriumfibrilleren/"],"congress":"","summary_en":"This ARTESIA subanalysis showed that the benefit of apixaban over aspirin for device-detected subclinical AF increases with higher CHA₂DS₂-VASc scores, supporting risk-stratified anticoagulation decisions for subclinical arrhythmia.","created":"2026-07-03T10:31:04Z","updated":"2026-07-03T13:30:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van ARTESIA toonde dat het voordeel van apixaban boven aspirine bij subclinisch AF toenam met hogere CHA₂DS₂-VASc-scores. Risicostratificatie helpt de balans tussen trombosepreventie en bloedingsrisico bij subclinisch AF.","abstract_original":"BACKGROUND: ARTESiA (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation) demonstrated that apixaban, compared with aspirin, significantly reduced stroke and systemic embolism (SE) but increased major bleeding in patients with subclinical atrial fibrillation. OBJECTIVES: To help inform decision making, the authors evaluated the efficacy and safety of apixaban according to baseline CHA2DS2-VASc score. METHODS: We performed a subgroup analysis according to baseline CHA2DS2-VASc score and assessed both the relative and absolute differences in stroke/SE and major bleeding. RESULTS: Baseline CHA2DS2-VASc scores were <4 in 1,578 (39.4%) patients, 4 in 1,349 (33.6%), and >4 in 1,085 (27.0%). For patients with CHA2DS2-VASc >4, the rate of stroke was 0.98%/year with apixaban and 2.25%/year with aspirin; compared with aspirin, apixaban prevented 1.28 (95% CI: 0.43-2.12) strokes/SE per 100 patient-years and caused 0.68 (95% CI: -0.23 to 1.57) major bleeds. For CHA2DS2-VASc <4, the stroke/SE rate was 0.85%/year with apixaban and 0.97%/year with aspirin. Apixaban prevented 0.12 (95% CI: -0.38 to 0.62) strokes/SE per 100 patient-years and caused 0.33 (95% CI: -0.27 to 0.92) major bleeds. For patients with CHA2DS2-VASc =4, apixaban prevented 0.32 (95% CI: -0.16 to 0.79) strokes/SE per 100 patient-years and caused 0.28 (95% CI: -0.30 to 0.86) major bleeds. CONCLUSIONS: One in 4 patients in ARTESiA with subclinical atrial fibrillation had a CHA2DS2-VASc score >4 and a stroke/SE risk of 2.2% per year. For these patients, the benefits of treatment with apixaban in preventing stroke/SE are greater than the risks. The opposite is true for patients with CHA2DS2-VASc score <4. A substantial intermediate group (CHA2DS2-VASc =4) exists in which patient preferences will inform treatment decisions. (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation; NCT01938248)."}