What Is the Optimal Strategy for Patients with Atrial Fibrillation Undergoing PCI?

A post hoc analysis from the AUGUSTUS trial supports apixaban with a P2Y12 inhibitor without aspirin, irrespective of baseline bleeding and stroke risks.

A growing body of evidence strongly supports avoidance of triple therapy (an oral anticoagulant, a P2Y12 inhibitor, and aspirin) for patients with atrial fibrillation undergoing a percutaneous coronary intervention (PCI) or experiencing an acute coronary syndrome.

In this post hoc analysis from the AUGUSTUS trial (NEJM JW Cardiol May 2019 and N Engl J Med 2019; 380:1509), investigators assessed differences in safety and efficacy between four antithrombotic combinations of apixaban and vitamin K antagonist (VKA; open-label comparison) and aspirin and placebo (double-blind comparison) according to baseline bleeding risk (measured by HAS-BLED score) and stroke risk (measured by the CHA₂DS₂-VASc score).

A total of 4614 patients were randomized in…

Reviewing Author

Fatima Rodriguez, MD, MPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardNovoNordisk; HealthPals; Novartis; Amgen

EquityHealthPals; Carta

Grant/Research SupportNational Institutes of Health/National Heart, Lung, and Blood Institute; American Heart Association–Robert Wood Johnson Foundation

Editorial BoardsCardiology and Therapy