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Getting the latest healthcare news for you
Getting the latest healthcare news for you
Blood thinners for borderline AFib patients? A new trial says maybe. The SINGLE-AF trial found that DOAC therapy cut the composite risk of stroke, embolism, major bleeding, or cardiovascular death by two-thirds in atrial fibrillation patients with intermediate stroke risk. But experts caution the low event rates make this thought-provoking, not practice-changing — and larger, more diverse studies are still needed.
The SINGLE-AF trial — the first randomized controlled trial of its kind — found that direct oral anticoagulants (DOACs) may benefit atrial fibrillation (AF) patients who fall into an intermediate stroke risk category based on their CHA₂DS₂-VASc score. Presented at the ESC Congress 2026 and simultaneously published in the New England Journal of Medicine, the trial enrolled 1,803 patients in South Korea and randomized them to DOAC therapy (apixaban or rivaroxaban) or no routine anticoagulation.
The results showed a meaningful reduction in the composite endpoint, but experts are urging caution. The low number of events means the magnitude of benefit may be overstated, and the findings may not generalize beyond the South Korean population studied. The lead researcher hopes the results will support expanded reimbursement for DOACs in this patient group.
By the Numbers:
Why it matters: Current AF guidelines only give a weak (Class IIa) recommendation for anticoagulation in intermediate-risk patients. SINGLE-AF offers the first RCT-level evidence to support treatment in this gray zone — but given the small event numbers and single-country design, clinicians should use these findings to inform shared decision-making rather than change practice outright.
