ARTESiA (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation) demonstrated that apixaban, compared with aspirin, significantly reduced stroke and systemic embolism (SE) but increased major bleeding in patients with subclinical atrial fibrillation. To help inform decision making, the authors evaluated the efficacy and safety of apixaban according to baseline CHADS-VASc score. We performed a subgroup analysis according to baseline CHADS-VASc score and assessed both the relative and absolute differences in stroke/SE and major bleeding. Baseline CHADS-VASc scores were <4 in 1,578 (39.4%) patients, 4 in 1,349 (33.6%), and >4 in 1,085 (27.0%). For patients with CHADS-VASc >4, the rate of stroke was 0.98%/year with apixaban and 2.25%/year with aspirin; compared with aspirin, apixaban prevented 1.28 (95% CI: 0.43-2.12) strokes/SE per 100 patient-years and caused 0.68 (95% CI: −0.23 to 1.57) major bleeds. For CHADS-VASc <4, the stroke/SE rate was 0.85%/year with apixaban and 0.97%/year with aspirin. Apixaban prevented 0.12 (95% CI: −0.38 to 0.62) strokes/SE per 100 patient-years and caused 0.33 (95% CI: −0.27 to 0.92) major bleeds. For patients with CHADS-VASc =4, apixaban prevented 0.32 (95% CI: −0.16 to 0.79) strokes/SE per 100 patient-years and caused 0.28 (95% CI: −0.30 to 0.86) major bleeds. One in 4 patients in ARTESiA with subclinical atrial fibrillation had a CHADS-VASc score >4 and a stroke/SE risk of 2.2% per year. For these patients, the benefits of treatment with apixaban in preventing stroke/SE are greater than the risks. The opposite is true for patients with CHADS-VASc score <4. A substantial intermediate group (CHADS-VASc =4) exists in which patient preferences will inform treatment decisions. (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation; )

中文翻译：

---

根据 CHA2DS2-VASc 评分的阿哌沙班与阿司匹林在亚临床心房颤动中的疗效：来自 ARTESiA 的见解


ARTESiA （阿哌沙班用于减少设备检测到的亚临床心房颤动患者的血栓栓塞）表明，与阿司匹林相比，阿哌沙班显着减少了中风和全身性栓塞 （SE），但增加了亚临床心房颤动患者的大出血。为了帮助做出决策，作者根据基线 CHADS-VASc 评分评估了阿哌沙班的疗效和安全性。我们根据基线 CHADS-VASc 评分进行亚组分析，并评估了卒中/SE 和大出血的相对和绝对差异。基线 CHADS-VASc 评分为 1,578 例 （39.4%） 患者 <4,1,349 例 （33.6%） 4 例，1,085 例 （27.0%） >4。对于 CHADS-VASc >4 患者，阿哌沙班组的卒中发生率为 0.98%/年，阿司匹林组的卒中发生率为 2.25%/年;与阿司匹林相比，阿哌沙班每 100 患者年预防了 1.28 （95% CI： 0.43-2.12） 中风/SE，并导致 0.68 （95% CI： -0.23 至 1.57） 大出血。对于 CHADS-VASc <4，阿哌沙班组的卒中/SE 发生率为 0.85%/年，阿司匹林组为 0.97%/年。阿哌沙班预防了每 100 患者年 0.12 （95% CI： -0.38 至 0.62） 中风/SE，并导致 0.33 （95% CI： -0.27 至 0.92） 大出血。对于 CHADS-VASc =4 的患者，阿哌沙班每 100 患者年预防了 0.32 （95% CI： -0.16 至 0.79） 次卒中/SE，并导致 0.28 （95% CI： -0.30 至 0.86） 次大出血。ARTESiA 亚临床心房颤动患者中 1/4 的 CHADS-VASc 评分为 >4，卒中/SE 风险为每年 2.2%。对于这些患者，阿哌沙班治疗预防中风/SE 的益处大于风险。对于 CHADS-VASc 评分 <4 的患者，情况正好相反。 存在大量的中间组 （CHADS-VASc =4），其中患者的偏好将为治疗决策提供信息。（阿哌沙班用于减少设备检测到的亚临床心房颤动患者的血栓栓塞;