SINGLE-AF — DOAC for AF With a Single Stroke Risk Factor
SINGLE-AF — DOAC for AF With a Single Stroke Risk Factor
Sources: Heart, October 1, 2026; NEJM; ESC 2026.
• 1,803 patients with AF and CHA₂DS₂-VA = 1 → DOAC vs no anticoagulation.
• Primary outcome at 24 months: 0.5% vs 1.5% (4 vs 13 events).
• Stroke: 0.15%/yr vs 0.55%/yr (3 vs 10 strokes).
• Major bleeding: low in both groups; too few events for a reliable bleeding estimate.
• AF burden matters: 72% had paroxysmal AF and 31% had prior AF ablation → relatively low AF burden may partly explain the low absolute stroke rate.
• AF burden = how much AF occurs over time (duration/frequency or % of monitored time in AF), not simply AF present/absent.
• Device-detected AF: very short/low-burden episodes carry lower absolute stroke risk than sustained clinical AF; randomized data such as ARTESiA show a modest stroke reduction with apixaban but increased major bleeding.
• Clinical message: CHA₂DS₂-VA = 1 → DOAC may be considered/encouraged, but AF burden can refine the decision; very low burden may favor no OAC in selected patients.
https://pubmed.ncbi.nlm.nih.gov/42823339/?utm_source=chatgpt.com
