In High-Risk AF Patients, NOAC Plus P2Y₁₂ Inhibitor Tied to Less Bleeding

By Kelly Young

Edited by Susan Sadoughi, MD

In patients with atrial fibrillation (AF) who are undergoing percutaneous coronary intervention (PCI) or who have concomitant acute coronary syndrome (ACS), a combination of a non-vitamin K antagonist oral anticoagulant (NOAC) plus a P2Y₁₂ inhibitor is associated with less bleeding than a vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT).

In a network meta-analysis in JAMA Cardiology, researchers analyzed four randomized, controlled trials comparing antithrombotic regimens in 10,000 patients who had ACS or were undergoing PCI for stable ACS or coronary artery disease.

Major bleeding was less common in both the group receiving NOAC plus P2Y₁₂ inhibitor (most commonly, clopidogrel) and that receiving VKA plus P2Y₁₂ inhibitor, compared with the VKA plus DAPT group.

Dr. Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, comments: "This study, even with its limitations and lack of attention to the costs of therapy, provides a welcome synthesis of existing evidence to suggest that NOACs plus P2Y₁₂ inhibitor (without aspirin) provide the best risk/benefit profile for patients with AF who underwent PCI. What is notable is that the findings indicate this regimen had lower risk of bleeding without an increase in the risk of ischemic complications."