Blood thinners (anticoagulants) cause bleeding without preventing stroke in patients with atrial high rate episodes (AHRE), but without electrocardiogram (ECG)-diagnosed atrial fibrillation, according to late breaking research presented in a Hot Line session today at ESC Congress 2023 and simultaneously published in the New England Journal of Medicine.
Anticoagulants prevent strokes in patients with atrial fibrillation but are not effective in those without atrial fibrillation, for example in patients with heart failure. Atrial high-rate episodes are short and rare atrial arrhythmias that resemble atrial fibrillation detected by implanted pacemakers, defibrillators, and loop recorders. AHRE are found in 10-30% of patients with implanted devices.
In 206 sites across 18 European countries, patients were randomly allocated in a 1:1 fashion to anticoagulation or no anticoagulation. Anticoagulation consisted of edoxaban in the dose approved for stroke prevention in atrial fibrillation . No anticoagulation consisted of placebo containing no active compound or aspirin 100 mg once daily in patients with an indication for antiplatelet therapy. The primary outcome was a composite of stroke, systemic embolism, or cardiovascular death.
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