Non-paroxysmal atrial fibrillation is associated with a highly significant increase in thromboembolism and death .
AIMS Thromboembolic risk stratification schemes and clinical guidelines for atrial fibrillation ( AF ) regard risk as independent of classification into paroxysmal ( PAF ) and non-paroxysmal atrial fibrillation ( NPAF ) .
The aim of the current study was to conduct a systematic review evaluating the impact of AF type on thromboembolism , bleeding , and mortality .
Outcomes of apixaban vs. warfarin by type and duration of atrial fibrillation: results from the ARISTOTLE trial.
AIMS It is uncertain whether the benefit from apixaban varies by type and duration of atrial fibrillation ( AF ) . METHODS AND RESULTS A total of 18 201 patients with AF [ 2786 ( 15.3 % ) with paroxysmal and 15 412 ( 84.7 % ) with persistent or permanent ] were r and omized to apixaban or warfarin .  In this pre-specified secondary analysis , we compared outcomes and treatment effect of apixaban vs. warfarin by AF type and duration . The primary efficacy endpoint was a composite of ischaemic or haemorrhagic stroke or systemic embolism . The secondary efficacy endpoint was all-cause mortality . There was a consistent reduction in stroke or systemic embolism ( P for interaction = 0.71 ) , all-cause mortality ( P for interaction = 0.75 ) , and major bleeding ( P for interaction = 0.50 ) with apixaban compared with warfarin for both AF types . Apixaban was superior to warfarin in all studied endpoints , regardless of AF duration at study entry ( P for all interactions > 0.13 ) . The rate of stroke or systemic embolism was significantly higher in patients with persistent or permanent AF than patients with paroxysmal AF ( 1.52 vs. 0.98 % ; P = 0.003 , adjusted P = 0.015 ) . There was also a trend towards higher mortality in patients with persistent or permanent AF ( 3.90 vs. 2.81 % ; P = 0.0002 , adjusted P = 0.066 ) . CONCLUSION The risks of stroke , mortality , and major bleeding were lower with apixaban than warfarin regardless of AF type and duration . Although the risk of stroke or systemic embolism was lower in paroxysmal than persistent or permanent AF , apixaban is an attractive alternative to warfarin in patients with AF and at least one other risk factor for stroke , regardless of the type or duration of AF
Non-paroxysmal atrial fibrillation is associated with a highly significant increase in thromboembolism and death .
AIMS Thromboembolic risk stratification schemes and clinical guidelines for atrial fibrillation ( AF ) regard risk as independent of classification into paroxysmal ( PAF ) and non-paroxysmal atrial fibrillation ( NPAF ) .
The aim of the current study was to conduct a systematic review evaluating the impact of AF type on thromboembolism , bleeding , and mortality .