Important New Studies on Managing Atrial Fibrillation

Atrial fibrillation (AF) and coronary artery disease (CAD) often coexist, but how do we best use anticoagulants and antiplatelet agents to balance efficacy and bleeding risk? To address this question in patients with recently symptomatic CAD, researchers enrolled 4600 patients with AF and acute coronary syndrome or percutaneous coronary intervention (PCI) during the previous 2 weeks. In addition to receiving a P2Y₁₂ inhibitor (most often clopidogrel), patients were randomized twice — to apixaban or a vitamin K antagonist (VKA), and to aspirin or placebo. Both clinically significant bleeding and a composite endpoint of hospitalization or death were less common with apixaban than with VKA, and aspirin led to more bleeding without significantl…