Furthermore, the presence of both ANA and ACR/EULAR-aPL positivity significantly increased the likelihood of the composite endpoint (OR = 4.85, 95%CI 1.75-13.43).<h4>Conclusions</h4>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. Here, BTG3 is linked to atrial fibrillation.