Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Lopes, RD; Heizer, G; Aronson, R; Vora, AN; Massaro, T; Mehran, R; Goodman, SG; Windecker, S; Darius, H; Li, J; Averkov, O; Bahit, MC; Berwanger, O; Budaj, A; Hijazi, Z; Parkhomenko, A; Sinnaeve, P; Storey, RF; Thiele, H; Vinereanu, D; Granger, CB; Alexander, JH; AUGUSTUS Investigators.
Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation.
N Engl J Med. 2019; 380(16): 1509-1524.
Doi: 10.1056/NEJMoa1817083
[OPEN ACCESS]
Web of Science
PubMed
FullText
FullText_MUG
- Study Group Mitglieder der Med Uni Graz:
- Scherr Daniel
- Altmetrics:
- Dimensions Citations:
- Plum Analytics:
- Scite (citation analytics):
- Abstract:
- Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. In an international trial with a two-by-two factorial design, we randomly assigned patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y12 inhibitor to receive apixaban or a vitamin K antagonist and to receive aspirin or matching placebo for 6 months. The primary outcome was major or clinically relevant nonmajor bleeding. Secondary outcomes included death or hospitalization and a composite of ischemic events. Enrollment included 4614 patients from 33 countries. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. Major or clinically relevant nonmajor bleeding was noted in 10.5% of the patients receiving apixaban, as compared with 14.7% of those receiving a vitamin K antagonist (hazard ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.81; P<0.001 for both noninferiority and superiority), and in 16.1% of the patients receiving aspirin, as compared with 9.0% of those receiving placebo (hazard ratio, 1.89; 95% CI, 1.59 to 2.24; P<0.001). Patients in the apixaban group had a lower incidence of death or hospitalization than those in the vitamin K antagonist group (23.5% vs. 27.4%; hazard ratio, 0.83; 95% CI, 0.74 to 0.93; P = 0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group. In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a vitamin K antagonist, aspirin, or both. (Funded by Bristol-Myers Squibb and Pfizer; AUGUSTUS ClinicalTrials.gov number, NCT02415400.). Copyright © 2019 Massachusetts Medical Society.
- Find related publications in this database (using NLM MeSH Indexing)
- Acute Coronary Syndrome - complications
- Acute Coronary Syndrome - therapy
- Aged -
- Aged, 80 and over -
- Anticoagulants - adverse effects
- Anticoagulants - therapeutic use
- Aspirin - adverse effects
- Aspirin - therapeutic use
- Atrial Fibrillation - complications
- Atrial Fibrillation - drug therapy
- Double-Blind Method -
- Drug Therapy, Combination -
- Factor Xa Inhibitors - adverse effects
- Factor Xa Inhibitors - therapeutic use
- Female -
- Hemorrhage - chemically induced
- Humans -
- Male -
- Middle Aged -
- Percutaneous Coronary Intervention -
- Platelet Aggregation Inhibitors - therapeutic use
- Purinergic P2Y Receptor Antagonists - therapeutic use
- Pyrazoles - adverse effects
- Pyrazoles - therapeutic use
- Pyridones - adverse effects
- Pyridones - therapeutic use
- Vitamin K - antagonists & inhibitors