DOACs Reduce Cardiovascular Events in Atrial Fibrillation at Intermediate Stroke Risk

In patients with atrial fibrillation at intermediate risk for stroke, direct oral anticoagulant (DOAC) therapy significantly reduced the 24-month risk of a composite of stroke, systemic embolism, major bleeding, or cardiovascular death compared with no anticoagulation. In the Korean multicenter, open-label, adjudicator-masked randomized trial, 1,803 patients with a CHA₂DS₂-VASc score of 1 in men or 2 in women were assigned to receive either a DOAC or no anticoagulant therapy. At 24 months, the primary end point occurred in 0.5% of patients in the DOAC group versus 1.5% in the no-anticoagulant group (hazard ratio, 0.31). Stroke occurred in 0.3% and 1.1% of patients, respectively, while systemic embolism and major bleeding appeared similar between groups, and no cardiovascular deaths occurred in either group. Serious adverse events were also comparable, occurring in 8.9% of the DOAC group and 9.3% of the no-anticoagulant group, supporting the benefit of DOAC therapy for patients with atrial fibrillation at intermediate stroke risk. Source: https://www.nejm.org/