Anticoagulation reduced stroke and bleeding composite in atrial fibrillation at intermediate risk

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 direct oral anticoagulant or none. At 24 months, the composite of stroke, systemic embolism, major bleeding or cardiovascular death occurred in 0.5% with anticoagulation and 1.5% without (HR 0.31, 95% CI 0.10 to 0.94), mostly from fewer strokes; major bleeding appeared similar. The trial was open label with few events. An individual-patient meta-analysis of 63 reported cases of repeat thrombolysis within 90 days of a previous treated stroke found no symptomatic haemorrhage and favourable outcomes in two-thirds, but the evidence is case-level and selected. An expert consensus on agitation in Alzheimer dementia recommends validated assessment, excluding reversible causes and non-drug measures first, choosing drugs by safety. In the China Kadoorie Biobank, higher exhaled carbon monoxide in never-smokers was associated with lower Parkinson disease risk, a finding that may explain the smoking association but is not advice. A meta-analysis found slowly expanding lesions in 78% of people with multiple sclerosis.