Oral anticoagulants reduce stroke risk in atrial fibrillation patients

New clinical data regarding stroke prevention in patients with atrial fibrillation (AF) highlight the efficacy of oral anticoagulants (OAC) and compare them to procedural alternatives.

The SINGLE-AF trial, presented at the European Society of Cardiology Congress, provided the first randomized evidence that direct oral anticoagulants (DOACs), specifically apixaban and rivaroxaban, reduce the risk of stroke, systemic embolism, major bleeding, and cardiovascular death in patients at intermediate stroke risk. This supports current guidelines that suggest considering OAC for patients in this risk category.

In a separate systematic review and meta-analysis published in JAMA Cardiology, researchers evaluated transcatheter left atrial appendage closure (LAAC) as an alternative to OAC. The study, which analyzed eight randomized clinical trials involving 7,434 patients, found that while LAAC showed similar overall stroke and major bleeding rates compared to OAC, it was associated with a 34% higher risk of ischemic stroke. Consequently, the findings suggest that LAAC should not be used as a routine first-line alternative to oral anticoagulation for stroke prevention in AF patients at moderate-to-high risk.