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Intermittent vs. Continuous Anticoagulation theRapy in patiEnts with Atrial Fibrillation (iCARE-AF): a randomized

Stavros Stavrakis1,2, Julie A Stoner3, Joel Kardokus4

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Intermittent anticoagulation using novel oral anticoagulants (NOACs) for paroxysmal atrial fibrillation (AF) is feasible. This approach may reduce bleeding events compared to continuous anticoagulation, warranting further investigation.

Keywords:
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Area of Science:

  • Cardiology
  • Pharmacology
  • Digital Health

Background:

  • Paroxysmal atrial fibrillation (AF) poses a significant stroke risk.
  • Anticoagulation is crucial for stroke prevention in AF patients.
  • Novel oral anticoagulants (NOACs) offer an alternative to traditional therapies.

Purpose of the Study:

  • To evaluate the feasibility and safety of intermittent anticoagulation for paroxysmal AF.
  • To assess the efficacy of daily rhythm monitoring with NOACs.
  • To compare bleeding rates between intermittent and continuous anticoagulation strategies.

Main Methods:

  • Randomized trial comparing intermittent vs. continuous anticoagulation in paroxysmal AF patients.
  • Intermittent group used iPhone-based ECG monitoring for NOAC initiation.
  • Continuous group received daily NOACs.

Main Results:

  • Feasible intermittent anticoagulation with 14% crossover to continuous therapy.
  • One stroke in the continuous group; major bleeding in 1/29 intermittent (post-crossover) and 2/29 continuous patients.
  • Gastrointestinal bleeding was significantly higher in the continuous group (16% vs. 0%).

Conclusions:

  • Intermittent anticoagulation guided by daily rhythm monitoring is feasible in paroxysmal AF.
  • This strategy may potentially reduce bleeding risks in select patients.
  • Larger trials are needed to confirm clinical outcomes and efficacy.