ANTICOAGULATION IN SUBCLINICAL ATRIAL FIBRILLATION: BALANCING STROKE PREVENTION AND BLEEDING RISK

Authors

  • João Gabriel Garrote Vasconcelos
  • Bianca Oliveira Bomfim
  • Luísa Campos Castro
  • Isabella de Oliveira e Castro
  • Ana Clara Bergamini Ferreira Pinheiro Rodrigues
  • Milena Dourado Brasileiro
  • Giovanna Rocha Placido Concesso
  • Gabriella Tolentino Fleury
  • Karine Harumi de Castro Shimasaki
  • Victhorya Maria Carvalho

DOI:

https://doi.org/10.63330/sasciencesv6n2-280

Keywords:

Anticoagulants, Atrial fibrillation, Hemorrhage, Shared decision-making, Stroke

Abstract

Device-detected subclinical atrial fibrillation is associated with an increased risk of stroke; however, decisions regarding anticoagulation in this population require an assessment of the potential benefits and harms of treatment. This narrative literature review aimed to analyze the evidence on oral anticoagulation in patients with subclinical atrial fibrillation, considering the prevention of thromboembolic events and the risk of bleeding. Randomized clinical trials, a meta-analysis, and a clinical guideline related to the topic were analyzed, with emphasis on the ARTESiA and NOAH-AFNET 6 trials. The findings indicated that anticoagulation may reduce the occurrence of ischemic stroke, although it is associated with an increased risk of major bleeding. Interpretation of the results should consider differences between studies, patient characteristics, and the absolute risks of each outcome. It is concluded that anticoagulation may be considered in selected patients following an individualized assessment of thromboembolic and bleeding risks, shared decision-making, and regular follow-up.

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References

HEALEY, Jeff S. et al. Apixaban for stroke prevention in subclinical atrial fibrillation. The New England Journal of Medicine, v. 390, n. 2, p. 107–117, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37952132/. Acesso em: 25 out. 2026.

JOGLAR, José A. et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, v. 83, n. 1, p. 109–279, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38043043/. Acesso em: 24 out. 2026.

KIRCHHOF, Paulus et al. Anticoagulation with edoxaban in patients with atrial high-rate episodes. The New England Journal of Medicine, v. 389, n. 13, p. 1167–1179, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37622677/. Acesso em: 22 out. 2026.

MCINTYRE, William F. et al. Direct oral anticoagulants for stroke prevention in patients with device-detected atrial fibrillation: a study-level meta-analysis of the NOAH-AFNET 6 and ARTESiA trials. Circulation, v. 149, n. 13, p. 981–988, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37952187/. Acesso em: 22 out. 2026.

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Published

2026-11-04

How to Cite

Vasconcelos, J. G. G. ., Bomfim, B. O. ., Castro, L. C. ., de Oliveira e Castro, I. ., Rodrigues, A. C. B. F. P. ., Brasileiro, M. D. ., Concesso, G. R. P. ., Fleury, G. T. ., Shimasaki, K. H. de C. ., & Carvalho, V. M. . (2026). ANTICOAGULATION IN SUBCLINICAL ATRIAL FIBRILLATION: BALANCING STROKE PREVENTION AND BLEEDING RISK . South American Sciences, 6(2), e26508. https://doi.org/10.63330/sasciencesv6n2-280

Issue

Vol. 6 No. 2 (2026): South American Sciences

Section

Artigos

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