- After acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI), patients with Afib have the fewest bleeding events and hospitalizations with apixaban (Eliquis; Pfizer and Bristol-Myers Squibb)+P2Y12 inhibitor.
- Editorial :
- Recommends routine direct oral anticoagulant (DOAC) for this population.
- Key unknown: whether coronary ischemia incidence rises without aspirin (for patients taking DOAC+clopidogrel [Plavix; Bristol-Myers Squibb]).
Why this matters
- Optimal antithrombotic regimen for these patients has been unclear, with competing risks among bleeding, cardioembolic stroke, and coronary ischemia.
- Apixaban vs vitamin K antagonists (VKAs):
- Primary outcome: 10.5% vs 14.7%.
- HR, 0.69 (95% CI, 0.58-0.81; P<.001 noninferiority and superiority>
- Aspirin vs placebo:
- Primary outcome, 16.1% vs 9.0%.
- HR, 1.89 (95% CI, 1.59-2.24; P<.001>
- Highest bleeding rate (18.7%) with VKA/aspirin.
- Lowest bleeding rate (7.3%) with apixaban/placebo.
- Lower death/hospitalization rate with apixaban, driven by fewer hospitalizations vs VKA.
- Similar death/hospitalization, ischemia rates with aspirin vs placebo.
- Randomized controlled multinational AUGUSTUS (N=4614), involving adults with Afib who were post-ACS and/or PCI.
- Researchers randomly allocated participants to 6 months of:
- apixaban vs VKA, or
- aspirin vs placebo.
- All took P2Y12 inhibitor.
- Outcome: major or clinically relevant nonmajor bleeding events per 100 patient-years.
- Funding: Bristol-Myers Squibb; Pfizer.
- Ischemia outcome exploratory.