Antinuclear antibodies as a risk factor for ischemic stroke or death in elderly patients with atrial fibrillation despite anticoagulation

Positive ANA coexisting with ACR/EULAR-aPL may contribute to the failure of oral anticoagulation in AF patients, highlighting a potential role of autoimmune mechanisms in thromboembolism associated with this common arrhythmia. Key Points • The role of antinuclear antibodies (ANA) in atrial fibrillation (AF) remains underexplored, despite their known association all-cause mortality. • This study addresses the gap by evaluating coexistence of ANA and antiphospholipid antibodies in accordance to ACR/EULAR (ACR/EULAR-aPL) in anticoagulated AF patients without autoimmune disease. • ANA positivity, particularly when coexisting with ACR/EULAR-aPL, was associated with an increased risk of thromboembolic events despite anticoagulation. • ANA was more frequently detected in patients who experienced the composite endpoint of ischaemic stroke, transient ischaemic attack, or cardiovascular death.