Blood thinners don’t benefit low-risk patients with atrial fibrillation
A new Canadian study presented at the American Heart Association’s Scientific Sessions in Chicago suggests that younger patients with atrial fibrillation (Afib) but no other risk factors for stroke may not benefit from blood-thinning medications. The study, involving 1,235 otherwise healthy adults under age 65 with Afib, found that prescribing anticoagulants did not reduce the patients’ risk of cognitive decline, strokes, or mini-strokes (transient ischemic attacks, or TIAs).
The trial, which was designed to last five years, was terminated early after an independent monitoring committee determined that the medication showed no benefit after an average follow-up of 3.7 years. The participants, all of whom lacked typical stroke risk factors such as diabetes, high blood pressure, or prior strokes, were randomly assigned to receive either 15 milligrams of rivaroxaban (marketed as Xarelto by Johnson & Johnson) or a placebo. The results showed no significant difference in the rates of cognitive decline, stroke, or TIA between the two groups. The combined annual rate of these events was 7% in the rivaroxaban group, compared to 6.4% in the placebo group.
Dr. Lena Rivard, study leader and researcher at Université de Montréal, explained, “Although numerous observational studies have reported an association between Afib and cognitive decline, we found that anticoagulation therapy initiated in relatively younger adults with Afib did not reduce this risk.”
The findings support current medical guidelines, which emphasize that younger individuals with Afib but no other stroke risk factors have a low likelihood of stroke, making anticoagulation therapy unnecessary for preventing cognitive decline. “In clinical practice, people younger than age 65 with Afib tend to be overtreated with anticoagulant therapy, while older people who have indications for anticoagulation are under-treated,” Dr. Rivard said.
In a separate study, researchers presented at the AHA meeting reported that reconditioned pacemakers, previously used in U.S. patients, were found to work as effectively as new devices in a trial involving nearly 300 people across seven low- and middle-income countries.
Although reusing pacemakers is prohibited in the United States, the U.S. Food and Drug Administration allows re-sterilized devices to be exported for reuse in countries where medical resources are scarce. The study showed that pacemakers with at least six years of battery life and proper electrical function were successfully reconditioned and reused after being recovered from deceased patients or those undergoing surgery to remove their existing devices.
While the study showed positive outcomes, it noted some limitations, including the self-reporting of blood pressure by participants using home monitoring equipment, which may have introduced bias. Additionally, the researchers cautioned that the findings may not be fully applicable to other ethnic populations. Nevertheless, study leader Dr. Guang Ning of Ruijin Hospital at Shanghai Jiao Tong University School of Medicine emphasized the potential impact, saying, “The results provide strong support for the use of reconditioned pacemakers in countries with limited access to life-saving medical devices.”
The study highlights the promise of reusing pacemakers in low-resource settings, offering a cost-effective solution to help patients who would otherwise not have access to this critical treatment.
