geoffrey modest medical blogs

  A recent article found that short-lasting, asymptomatic intervals of atrial fibrillation (“subclinical atrial fibrillation”)   were  associated with a significantly increased risk of stroke; and apixaban, vs aspirin, was effective in decreasing stroke or systemic embolism, though at a cost of increased bleeding  (see  afib subclinical apix helps NEJM2023  in dropbox, or  DOI: 10.1056/NEJMoa2310234 )   Details : -- 4012 patients from 247 clinical sites  in  16 European and North American countries who had subclinical atrial fibrillation (SCAF) lasting 6 minutes to 24 hours,  as  determined  from  their long-term continuous monitoring with pacemakers or defibrillators, were randomized to apixaban 5 mg twice a day (2.5 mg if indicated) versus aspirin 81 mg daily, in the ARTESIA trial -- eligible participants also a CHA 2 DS 2 -VASc score of at least 3, and subsequent  protocol  amendments raised the minimum a...

  Another article on atrial fibrillation (AF) was just published, finding that warfarin was superior to rivaroxaban in those with rheumatic heart disease (see   afib warf better than rivarox in RHD NEJM2022  in dropbox or DOI: 10.1056/NEJMoa2209051)   Details: -- 4531 patients with atrial fibrillation or atrial flutter and echocardiographically documented rheumatic heart disease who had any of:      -- CHA 2  DS 2 VASc score of at least 2      -- or echocardiographic mitral-valve area of no more than 2 cm 2 , left atrial spontaneous echo contrast, or left atrial thrombus -- mean age of the patients was 51 years, 72% were women, BMI 24.5 -- eGFR 81, heart failure 39%, hypertension 23% (mean SBP 116 mmHg), stroke 11% -- CHA 2  DS 2 VASc score 1.9 -- patients were from Africa, Asia, and Latin Amercia -- those who were included in the study were because of:  mitral stenosis in 82%,  CHA 2  DS 2 VASc score i...