# ARTESIA: apixaban versus aspirine naar CHA₂DS₂-VASc bij subclinisch AF

*geplaatst 2024-07-23 · Atriumfibrilleren · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2024.05.002 · https://hartvaat.nl/2024/07/23/artesia-apixaban-versus-aspirine-naar-cha2ds2-vasc-bij-subclinisch-af/*

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.

## English: Apixaban vs Aspirin According to CHA2DS2-VASc Score in Subclinical Atrial Fibrillation: Insights From ARTESiA.

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.

## Abstract (original, from the publication)

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).

Auteurs: 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

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2024.05.002. Bijgewerkt 2026-07-03T13:30:06Z. 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.