AF at intermediate stroke risk: a first randomised trial favours starting a DOAC

The edition in brief

SINGLE-AF randomised 1,803 Korean patients with atrial fibrillation at intermediate stroke risk (CHA₂DS₂-VASc 1 in men, 2 in women) to a DOAC or no anticoagulation. At 24 months the composite of stroke, embolism, major bleeding or cardiovascular death occurred in 0.5% against 1.5% (HR 0.31, 0.10 to 0.94), with stroke 0.3% against 1.1% and no clear excess in major bleeding; event numbers were small. STAREE randomised 9,971 Australians aged 70 or over without cardiovascular disease, diabetes or dementia to atorvastatin 40 mg or placebo. Over 5.9 years, major cardiovascular events fell (10.9 vs 15.5 per 1,000 person-years, HR 0.70), but death, dementia or persistent disability did not (HR 0.94, 0.84 to 1.05). PRAGUE-26 randomised 558 patients with intermediate-high-risk pulmonary embolism to catheter-directed alteplase plus anticoagulation or anticoagulation alone: death, recurrence or collapse within 7 days fell from 6.8% to 0.7%, without more major bleeding, though 2 intracranial haemorrhages occurred with thrombolysis. The ORBEX trial found the bacterial lysate OM-85, given to 822 high-risk infants for two years, did not prevent wheezing illness (HR 1.16, 0.82 to 1.64). And PRESC1SE-MI, a 67,624-presentation cluster trial, found switching from a 0/3 h to a 0/1 h troponin pathway was safe but did not shorten emergency department stays.