Anticoagulation in Device-Detected Atrial Fibrillation—Uncertainty and Heterogeneity in Value

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Anticoagulation for subclinical, device-detected atrial fibrillation (AF) has been studied in randomized trials, revealing a trade-off between benefit and harm.
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The ARTESiA and NOAH-AFNET 6 trials showed a 32% reduction in ischemic stroke risk with direct oral anticoagulants (DOACs) but increased major bleeding risk.
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The 2024 European Society of Cardiology guidelines recommend considering DOACs for selected patients with high stroke risk and no major bleeding risk factors.
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A cost-effectiveness analysis indicated that routine anticoagulation for all patients with device-detected AF is unlikely to represent high-value care.
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Further risk stratification is needed, as patients with higher CHA2DS2-VASc scores may benefit more from DOAC therapy compared to those with lower scores.

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