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Hiteshi K.C. Chauhan: Should Patients with AF and Intermediate Stroke Risk Receive Anticoagulation?

Hiteshi K.C. Chauhan/LinkedIn

Aug 29, 2026, 14:54

Hiteshi K.C. Chauhan: Should Patients with AF and Intermediate Stroke Risk Receive Anticoagulation?

Hiteshi K.C. Chauhan, Consultant, Department of Cardiology at Fortis Healthcare, shared a post on LinkedIn:

“That long-standing question in atrial fibrillation finally has randomized-trial evidence.

Should patients with AF and intermediate stroke risk receive anticoagulation?

The SINGLE-AF trial, presented at ESC Congress 2026, randomized 1,803 patients with AF and CHA₂DS₂-VASc 1 in men / 2 in women to DOAC therapy or no DOAC, with 2 years of follow-up.

The primary composite outcome — stroke, systemic embolism, major bleeding or cardiovascular death — occurred in:

DOAC: 0.5%
No DOAC: 1.5%

HR 0.31 (95% CI 0.10–0.94; p=0.028)

That corresponds to approximately a 69% relative reduction and a 1 percentage-point absolute reduction.

Importantly, major bleeding was not increased:

0.3% with DOAC vs 0.5% without DOAC.

The take-home message:

In this selected population with AF and intermediate stroke risk, DOAC therapy reduced the composite of thromboembolic events, major bleeding and cardiovascular death, with the benefit driven largely by fewer ischemic strokes.

This is important because the benefit at this level of stroke risk has historically been an area of uncertainty.

Also, of utmost importance – stroke risk in AF is dynamic with 50% of patients with CHA₂DS₂-VA 0–1 acquiring a new risk factor within a median of only 2 years.

Small absolute risk reduction. Potentially very important when the event being prevented is stroke.”

Hiteshi K.C. Chauhan