# Anticoagulatie bij device-gedetecteerd AF met/zonder vaatlijden: NOAH+ARTESIA gecombineerd

*geplaatst 2024-12-07 · Atriumfibrilleren · European heart journal · doi 10.1093/eurheartj/ehae596 · https://hartvaat.nl/2024/12/07/anticoagulatie-bij-device-gedetecteerd-af-met-zonder-vaatlijden-noah-artesia-gec/*

Gecombineerde analyse van NOAH en ARTESIA onderzocht anticoagulatie bij subclinisch AF stratificerend naar vaatlijden. Het voordeel was het grootst bij patiënten met vasculaire ziekte, wat de behandelbeslissing kan individualiseren.

## English: Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials.

This combined NOAH-ARTESIA analysis examined whether concomitant vascular disease modifies the benefit of anticoagulation for device-detected subclinical AF, informing risk-stratified treatment decisions in this growing patient population.

## Abstract (original, from the publication)

BACKGROUND AND AIMS: The optimal antithrombotic therapy in patients with device-detected atrial fibrillation (DDAF) is unknown. Concomitant vascular disease can modify the benefits and risks of anticoagulation. METHODS: These pre-specified analyses of the NOAH-AFNET 6 (n = 2534 patients) and ARTESiA (n = 4012 patients) trials compared anticoagulation with no anticoagulation in patients with DDAF with or without vascular disease, defined as prior stroke/transient ischaemic attack, coronary or peripheral artery disease. Efficacy outcomes were the primary outcomes of both trials, a composite of stroke, systemic arterial embolism (SE), myocardial infarction, pulmonary embolism or cardiovascular death, and stroke or SE. Safety outcomes were major bleeding or major bleeding and death. RESULTS: In patients with vascular disease (NOAH-AFNET 6, 56%; ARTESiA, 46%), stroke, myocardial infarction, systemic or pulmonary embolism, or cardiovascular death occurred at 3.9%/patient-year with and 5.0%/patient-year without anticoagulation (NOAH-AFNET 6), and 3.2%/patient-year with and 4.4%/patient-year without anticoagulation (ARTESiA). Without vascular disease, outcomes were equal with and without anticoagulation (NOAH-AFNET 6, 2.7%/patient-year; ARTESiA, 2.3%/patient-year in both randomized groups). Meta-analysis found consistent results across both trials (I2heterogeneity = 6%) with a trend for interaction with randomized therapy (pinteraction = .08). Stroke/SE behaved similarly. Anticoagulation equally increased major bleeding in vascular disease patients [edoxaban, 2.1%/patient-year; no anticoagulation, 1.3%/patient-year; apixaban, 1.7%/patient-years; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.55 (1.10-2.20)] and without vascular disease [edoxaban, 2.2%/patient-year; no anticoagulation, 0.6%/patient-year; apixaban, 1.4%/patient-year; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.93 (0.72-5.20)]. CONCLUSIONS: Patients with DDAF and vascular disease are at higher risk of stroke and cardiovascular events and may derive a greater benefit from anticoagulation than patients with DDAF without vascular disease.

Auteurs: Renate B Schnabel, Juan Benezet-Mazuecos, Nina Becher, William F McIntyre, Alexander Fierenz, Shun Fu Lee, Andreas Goette, Dan Atar, Emanuele Bertaglia, Alexander P Benz, Gregory Chlouverakis, David H Birnie, Wolfgang Dichtl, Carina Blomstrom-Lundqvist, A John Camm, Julia W Erath, Emmanuel Simantirakis, Valentina Kutyifa, Gregory Y H Lip, Philippe Mabo, Eloi Marijon, Lena Rivard, Ulrich Schotten, Marco Alings, Susanne Sehner, Tobias Toennis, Cecilia Linde, Panos Vardas, Christopher B Granger, Antonia Zapf, Renato D Lopes, Jeff S Healey, Paulus Kirchhof

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehae596. Bijgewerkt 2026-07-03T13:30:22Z. 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.