Reevaluating the Role of Anticoagulation in Patients with Device-Detected Atrial Fibrillation
New findings from the NOAH—AFNET 6 trial suggest that anticoagulation offers minimal benefit and increased risks for patients with device-detected atrial fibrillation, emphasizing personalized treatment strategies.
Recent research indicates that anticoagulation therapy may not provide a significant benefit for patients with device-detected atrial fibrillation (DDAF). The NOAH—AFNET 6 trial, conducted by the AFNET and presented at the European Society of Cardiology (ESC) Congress in Madrid, utilized a Win Ratio analysis to assess the effectiveness of edoxaban, a direct oral anticoagulant, compared to no anticoagulation in this patient population.
The study involved 2,534 participants and aimed to determine whether anticoagulation could meaningfully reduce stroke risk and other adverse cardiovascular events. While initial findings suggested a slight reduction in stroke risk, this benefit was counterbalanced by an increased risk of major bleeding. As a result, the trial was halted early due to concerns over bleeding, which outweighed the modest stroke prevention advantage.
Dr. Nina Becher from the University Medical Center Hamburg-Eppendorf explained that the hierarchical win ratio analysis prioritized more severe events such as death and stroke over less impactful outcomes like bleeding. The analysis revealed that most patients with device-detected AF did not experience significant events during follow-up, and overall, anticoagulation with edoxaban did not outperform no treatment.
The study underscores the importance of personalized decision-making when considering anticoagulation therapy in DDAF patients. Prof. Paulus Kirchhof emphasized that for most patients, a strategy involving no anticoagulation with regular ECG monitoring might be appropriate, with treatment plans tailored to individual patient preferences and risk profiles. Further research may help identify specific subgroups who could benefit more from anticoagulation despite the associated bleeding risks.
These findings prompt a reevaluation of current clinical practices and highlight the need for careful risk-benefit assessment in managing patients with device-detected atrial fibrillation.
Source: https://medicalxpress.com/news/2025-09-anticoagulation-benefit-patients-device-atrial.html
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