People with atrial fibrillation at intermediate risk of stroke benefit from oral anticoagulants, clinical trial finds
Oral anticoagulant therapy lowered the risk of adverse clinical events compared with no anticoagulation in patients with atrial fibrillation at intermediate stroke risk, according to results from the SINGLE-AF trial presented in a Hot Line session at ESC Congress 2026 and published simultaneously in the New England Journal of Medicine.
A clinical trial called SINGLE-AF found that oral anticoagulants benefit people with atrial fibrillation at intermediate risk of stroke, according to the ESC Congress 2026 and published in the New England Journal of Medicine. Atrial fibrillation raises the risk of stroke, and the ESC recommends oral anticoagulants for high-risk patients (Class I) and suggests considering them for those at intermediate risk (Class IIa).
The SINGLE-AF trial, led by Boyoung Joung from Yonsei University, randomized 1,803 individuals with AF and intermediate stroke risk into either DOAC therapy (apixaban or rivaroxaban) or no anticoagulation. After 24 months, the risk of stroke, systemic embolism, major bleeding, or cardiovascular death was significantly reduced with DOACs (0.5% vs 1.5%, hazard ratio 0.31).
Ischemic stroke was also lower (0.1% vs 1.1%), but major bleeding was not significantly different between the two groups (0.3% vs 0.5%). The trial results support using DOACs to treat AF patients at intermediate stroke risk, potentially influencing future guidelines and insurance policies.
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