Anticoagulation for Stroke Prevention In Patients With Recent Episodes of Atrial Fibrillation Occurring Transiently With Stress

Prior treatment

• history of documented chronic AF prior to noncardiac surgery;
• expected to be non-compliant with follow-up and/or study medications;
• known life expectancy less than 1 year due to concomitant disease;
• previously enrolled in the trial

Other illness

• any cardiac diagnosis as the primary reason for hospital admission;
• severe renal insufficiency (CrCl \<20 ml/min);
• acute stroke in the past 14 days;
• underwent cardiac surgery in the past 35 days;
• history of nontraumatic intracranial, intraocular, or spinal bleeding;
• hemorrhagic disorder or bleeding diathesis;

Other

• need for long-term systemic anticoagulation;
• ongoing need for long-term dual antiplatelet treatment;
• contraindication to oral anticoagulation;
• severe liver cirrhosis (i.e., Child-Pugh Class C)
• women who are pregnant, breastfeeding, or of childbearing potential who are not taking effective contraception; OR

• have ≥1 episode of clinically important AFOTS during any of the following conditions:
  • noncardiac surgery in the past 35 days, with at least an overnight hospital admission aftersurgery;
  • noncardiac day surgery resulting in a large enough physiological insult to be able to cause AFOTS, as judged by the local investigator; or
  • acute medical illness requiring hospital admission in the past 35 days and resulting in a large enough physiological insult to be able to cause AFOTS, as judged by the local investigator;
• sinus rhythm at the time of randomization;
• any of the following high-risk criteria:
  • age 55-64 years, and having either known cardiovascular disease, recent major vascular surgery, a CHA2DS2VASc score ≥3, or an elevated postoperative troponin level;
  • age 65-74 years, and having either known cardiovascular disease, recent major vascular surgery, a CHA2DS2VASc score ≥2, or an elevated postoperative troponin level; OR
  • age ≥75 years.;
• provide written informed consent