For patients with atrial fibrillation and an intermediate risk for stroke, current guidelines suggest that direct oral anticoagulation should be considered, but data from randomized trials are lacking. Research findings from SINGLE-AF trial are summarized in a Quick Take video. nej.md/4zCtYit #ESCCongress
A illustration showing anticoagulation for atrial fibrillation with intermediate stroke risk. On the left, a medicine box labeled "Anticoagulant Tablets" with two pills is shown. In the center, a silhouette of a patient with a highlighted heart. Above, a round inset displays a heart rate monitor graph representing atrial fibrillation. To the right, a brain is depicted with an inset showing a blood vessel and a warning symbol, representing intermediate stroke risk.

ALT A illustration showing anticoagulation for atrial fibrillation with intermediate stroke risk. On the left, a medicine box labeled "Anticoagulant Tablets" with two pills is shown. In the center, a silhouette of a patient with a highlighted heart. Above, a round inset displays a heart rate monitor graph representing atrial fibrillation. To the right, a brain is depicted with an inset showing a blood vessel and a warning symbol, representing intermediate stroke risk.

Sep 25, 2026 · 8:00 PM UTC

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Replying to @NEJM
This is exactly where shared decision making matters. In atrial fibrillation with intermediate stroke risk, the potential benefit of anticoagulation must be weighed against bleeding risk and the patient’s individual risk factors. Randomized data in this group are especially valuable because “consider anticoagulation” leaves clinicians and patients with a difficult decision. The SINGLE AF trial should help clarify where the balance between preventing stroke and avoiding unnecessary bleeding lies.
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Replying to @NEJM
Encouraging first randomized data for a group where guidelines have long outpaced the evidence. That said, worth flagging: the composite endpoint was driven almost entirely by very few events, and individual outcomes like stroke alone didn't reach significance on their own.
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