When each device is compared incrementally , BioMonitor 2-AF dominates Reveal LINQ and Confirm RX .
BACKGROUND Cryptogenic stroke is a stroke for which no cause is identified after st and ard diagnostic tests .
Long-term implantable cardiac monitors may be better at diagnosing atrial fibrillation and provide an opportunity to reduce the risk of stroke recurrence with anticoagulants .
OBJECTIVES The objectives were to assess the diagnostic test accuracy , clinical effectiveness and cost-effectiveness of three implantable monitors [ BioMonitor 2-AF ™ ( Biotronik SE & Co. KG , Berlin , Germany ) , Confirm Rx ™ ( Abbott Laboratories , Lake Bluff , IL , USA ) and Reveal LINQ ™ ( Medtronic plc , Minneapolis , MN , USA ) ] in patients who have had a cryptogenic stroke and for whom no atrial fibrillation is detected after 24 hours of external electrocardiographic monitoring .
Apixaban versus aspirin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a predefined subgroup analysis from AVERROES, a randomised trial
BACKGROUND In the AVERROES study , apixaban , a novel factor Xa inhibitor , reduced the risk of stroke or systemic embolism in patients with atrial fibrillation who were at high risk of stroke but unsuitable for vitamin K antagonist therapy . We aim ed to investigate whether the subgroup of patients with previous stroke or transient ischaemic attack ( TIA ) would show a greater benefit from apixaban compared with aspirin than would patients without previous cerebrovascular events . METHODS In AVERROES , 5599 patients ( mean age 70 years ) with atrial fibrillation who were at increased risk of stroke and unsuitable for vitamin K antagonist therapy were r and omly assigned to receive apixaban ( 5 mg twice daily ) or aspirin ( 81 - 324 mg per day ) . The mean follow-up was 1·1 years . The primary efficacy outcome was stroke or systemic embolism ; the primary safety outcome was major bleeding . Patients and investigators were masked to study treatment . In this prespecified subgroup analysis , we used Kaplan-Meier estimates of 1-year event risk and Cox proportional hazards regression models to compare the effects of apixaban in patients with and without previous stroke or TIA . AVERROES is registered at Clinical Trials.gov , number NCT00496769 . FINDINGS In patients with previous stroke or TIA , ten events of stroke or systemic embolism occurred in the apixaban group ( n=390 , cumulative hazard 2·39 % per year ) compared with 33 in the aspirin group ( n=374 , 9·16 % per year ; hazard ratio [ HR ] 0·29 , 95 % CI 0·15 - 0·60 ) . In those without previous stroke or TIA , 41 events occurred in the apixaban group ( n=2417 , 1·68 % per year ) compared with 80 in the aspirin group ( n=2415 , 3·06 % per year ; HR 0·51 , 95 % CI 0·35 - 0·74 ) . The p value for interaction of the effects of aspirin and apixaban with previous cerebrovascular events was 0·17 . Major bleeding was more frequent in patients with history of stroke or TIA than in patients without ( HR 2·88 , 95 % CI 1·77 - 4·55 ) but risk of this event did not differ between treatment groups . INTERPRETATION In patients with atrial fibrillation  , apixaban is similarly effective whether or not patients have had a previous stroke or TIA . Given that those with previous stroke or TIA have a higher risk of stroke , the absolute benefits might be greater in these patients . FUNDING Bristol-Myers Squibb and Pfizer
When each device is compared incrementally , BioMonitor 2-AF dominates Reveal LINQ and Confirm RX .
BACKGROUND Cryptogenic stroke is a stroke for which no cause is identified after st and ard diagnostic tests .
Long-term implantable cardiac monitors may be better at diagnosing atrial fibrillation and provide an opportunity to reduce the risk of stroke recurrence with anticoagulants .
OBJECTIVES The objectives were to assess the diagnostic test accuracy , clinical effectiveness and cost-effectiveness of three implantable monitors [ BioMonitor 2-AF ™ ( Biotronik SE & Co. KG , Berlin , Germany ) , Confirm Rx ™ ( Abbott Laboratories , Lake Bluff , IL , USA ) and Reveal LINQ ™ ( Medtronic plc , Minneapolis , MN , USA ) ] in patients who have had a cryptogenic stroke and for whom no atrial fibrillation is detected after 24 hours of external electrocardiographic monitoring .