Date Published: August 1, 2017
Author(s): Paulus Kirchhof, Benjamin F. Blank, Melanie Calvert, A. John Camm, Gregory Chlouverakis, Hans-Christoph Diener, Andreas Goette, Andrea Huening, Gregory Y.H. Lip, Emmanuel Simantirakis, Panos Vardas.
Atrial fibrillation (AF) is a common cause of stroke, especially ischemic stroke. Unlike strokes of other major etiologies, which can be prevented by antiplatelet therapy, stroke prevention in patients with AF requires oral anticoagulation.1., 2., 3. Recently, 4 non–vitamin K antagonist oral anticoagulants (NOACs) have been introduced into clinical practice as alternatives to vitamin K antagonist (VKA) therapy.4., 5., 6., 7., 8. NOACs provide similar stroke prevention efficacy and are at least as safe as VKA,8., 9. with less intracranial hemorrhage and a 10% reduction in mortality in the pivotal trials.10
In summary, the optimal antithrombotic therapy in patients with AHRE but without diagnosed AF cannot be derived from existing data. The information gained from NOAH–AFNET 6 and from the ARTESiA trial (NCT01938248) will provide sound evidence to guide the use of oral anticoagulation in patients with device-detected AHRE and possibly in patients with atrial arrhythmias documented by other devices. The results have the potential to inform future guidance on the management of patients with atrial arrhythmias detected by implantable devices.