A large clinical trial presented at the European Society of Cardiology Congress found that patients with atrial fibrillation who face an intermediate risk of stroke had better outcomes when treated with direct oral anticoagulants than when given no anticoagulation at all.
The findings come from the SINGLE-AF trial, published in the New England Journal of Medicine. According to the trial results, patients in the intermediate-risk group who received direct oral anticoagulants — blood-thinning medicines that reduce the chance of clots forming — had a lower combined risk of stroke, systemic embolism (clots travelling to organs outside the brain), major bleeding, and death from heart or circulatory causes compared with those who received no anticoagulation treatment.
Atrial fibrillation, commonly called AF, is an irregular heart rhythm that allows blood to pool and clot inside the heart. Those clots can travel to the brain and cause a stroke. Doctors use risk scores to decide which AF patients need anticoagulant medicines — but patients in the so-called intermediate band have long sat in uncertain territory, with guidance varying between countries and clinicians.
The SINGLE-AF results suggest that uncertainty may now shift. By showing a measurable benefit across that combined outcome measure, the trial gives clinicians clearer evidence to weigh when discussing treatment options with patients who fall into this middle-risk category.
The research was presented at ESC Congress, one of the world’s largest cardiology conferences, and published simultaneously in the New England Journal of Medicine — a peer-reviewed medical journal.
AF affects around 1.4 million people in the UK, according to the NHS, and is one of the most common heart rhythm conditions seen in GP surgeries and cardiology clinics across Kent and Medway.
Anyone concerned about an irregular heartbeat or their current heart medication should speak to their GP rather than changing or stopping treatment on their own. The NHS advises that symptoms of AF — including a fluttering or pounding feeling in the chest, dizziness, or shortness of breath — should always be assessed by a doctor.
Where to get help
- Speak to your GP if you have concerns about heart rhythm or anticoagulant medicines
- Call NHS 111 for non-emergency medical advice, available 24 hours a day
- Dial 999 if you experience sudden chest pain, weakness on one side of the body, or difficulty speaking — these can be signs of a stroke or serious cardiac event
Source: @NEJM