Tailoring antithrombotic strategies for high-risk af populations

Access through your institution Buy or subscribe Patients with atrial fibrillation (AF) and a recent acute coronary syndrome (ACS) or who have undergone percutaneous coronary intervention

(PCI) often receive both antiplatelet therapy (to prevent ischaemic events and stent thrombosis) and oral anticoagulants (to prevent stroke and systemic embolism). However, how to select the

best antithrombotic regimen for this patient population to minimize the risk of bleeding without compromising protection is an important unanswered question. Now, results from the AUGUSTUS

trial, presented at ACC.19, indicate that in this high-risk group of patients, a regimen that includes a P2Y12 inhibitor plus apixaban, at the dose recommended for stroke prevention, without

aspirin results in less bleeding and fewer hospitalizations, without significant differences in ischaemic events, than the use of regimens that include a vitamin K antagonist (VKA), aspirin

or both. Apixaban was both noninferior and significantly superior to VKA for the primary outcome of major or clinically relevant nonmajor bleeding. The primary outcome occurred in 10.5% of

patients in the apixaban group and in 14.7% of those in the VKA group, a 31% reduction in the relative risk of bleeding with apixaban (HR 0.69, 95% CI 0.58–0.81, _P_ < 0.001 for both

noninferiority and superiority). Analysis of the secondary outcomes indicated a 17% reduction with apixaban in the relative risk of death or hospitalization compared with the use of a VKA,

which was primarily driven by a reduction in all-cause hospitalization. The incidence of the composite of death and ischaemic events was similar in both groups. This is a preview of

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* Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support REFERENCES ORIGINAL ARTICLE * Lopes, R. D. et al. Antithrombotic therapy after acute coronary

syndrome or PCI in atrial fibrillation. _N. Engl. J. Med._ https://doi.org/10.1056/NEJMoa1817083 (2019) Article  PubMed  Google Scholar  FURTHER READING * Capodanno, D. et al. Aspirin-free

strategies in cardiovascular disease and cardioembolic stroke prevention. _Nat. Rev. Cardiol._ 15, 480–496 (2018) Article  CAS  PubMed  Google Scholar  Download references AUTHOR INFORMATION

AUTHORS AND AFFILIATIONS * Nature Reviews Cardiology http://www.nature.com/nrcardio/ Irene Fernández-Ruiz Authors * Irene Fernández-Ruiz View author publications You can also search for

this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Irene Fernández-Ruiz. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE

Fernández-Ruiz, I. Tailoring antithrombotic strategies for high-risk AF populations. _Nat Rev Cardiol_ 16, 321 (2019). https://doi.org/10.1038/s41569-019-0195-0 Download citation *

Published: 01 April 2019 * Issue Date: June 2019 * DOI: https://doi.org/10.1038/s41569-019-0195-0 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this

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