🎙️ Episode 1: Silent A-Fib, Loud Decisions: ARTESIA and the ASA-Apixaban Showdown

Brilliant Board Review & CME

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🧠 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?”

Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ platform to earn CME/CE.

Chapters

1. 🎙️ Episode 1: Silent A-Fib, Loud Decisions: ARTESIA and the ASA-Apixaban Showdown (00:00:00)

2. Subclinical Atrial Fibrillation Explained (00:00:20)

3. ARTESIA Trial Overview (00:00:33)

4. Study Inclusion Criteria (00:01:02)

5. Key Findings and Results (00:01:28)

6. Human Impact of Stroke Prevention (00:02:18)

7. Modified Rankin Scale Explained (00:03:13)