Send us a text🧠 Clinical Context:Subclinical atrial fibrillation = asymptomatic episodes of AF detected by implantable monitors or Holters, lasting 6 minutes to 24 hours.Big Question: Should we anticoagulate these patients?🧪 Study Highlights – ARTESiA Trial:Design: 4,012 patients (mean age 76.8), randomized to apixaban 5 mg BID vs ASA 81 mg daily.Inclusion: Age >55 with or without history of stroke/TIA; device-confirmed subclinical AF.📈 Outcomes:Primary endpoint: Stroke or systemic embolism.With prior stroke/TIA:Apixaban significantly reduced events: 1.2% vs 3.4% annually.Without prior stroke/TIA:No significant difference: 0.74% (apixaban) vs 1.07% (ASA).🧩 Clinical Pearls:Don’t reflexively anticoagulate all device-detected AF — stratify by stroke history.Consider CHA₂DS₂-VASc, but more importantly, patient-specific functional risk.Use the Modified Rankin Scale to contextualize why stroke prevention matters:0 = no symptoms, 5 = severe disability, 6 = death.Patient framing tip: “If a stroke leaves you unable to walk, speak, or go to the bathroom independently, would that be worth preventing with a pill?”

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