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Published on: February 28, 2012
Aspirin versus P2Y12 inhibitors with anticoagulation therapy for atrial fibrillation
Hidehira Fukaya1, Junya Ako2, Satoshi Yasuda3,4
1Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Insights
For patients with coronary artery disease and atrial fibrillation on rivaroxaban, P2Y12 inhibitors and aspirin showed similar efficacy and safety. This study compared cardiovascular and bleeding events in these treatment groups.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Patients with coronary artery disease (CAD) and atrial fibrillation (AF) often require antithrombotic therapy, increasing bleeding risk.
- Balancing antithrombotic efficacy and bleeding risk is crucial in managing these patients.
Purpose of the Study:
- To evaluate the efficacy and safety of P2Y12 inhibitors versus aspirin in patients with stable CAD and AF receiving anticoagulant therapy.
- To compare cardiovascular events and bleeding risk between P2Y12 inhibitor and aspirin groups.
Main Methods:
- Analysis of patients from the AFIRE trial receiving rivaroxaban plus either a P2Y12 inhibitor or aspirin.
- Primary efficacy endpoint: composite of stroke, systemic embolism, myocardial infarction, unstable angina, or all-cause death.
- Primary safety endpoint: major bleeding events according to ISTH criteria.
Main Results:
- 1075 patients included: 297 in P2Y12 inhibitor group, 778 in aspirin group.
- No significant differences in primary efficacy (HR 1.31; p=0.178) or safety (HR 0.79; p=0.456) endpoints between groups.
- Proton pump inhibitor use was similar across groups (~60%).
Conclusions:
- No significant differences in cardiovascular or bleeding events were observed between P2Y12 inhibitors and aspirin in patients with AF and stable CAD on rivaroxaban.
- These findings suggest comparable safety and efficacy profiles for P2Y12 inhibitors and aspirin in this patient population during the chronic phase.
Objective:
Patients with coronary artery disease (CAD) and atrial fibrillation (AF) can be treated with multiple antithrombotic therapies including antiplatelet and anticoagulant therapies; however, this has the potential to increase bleeding risk. Here, we aimed to evaluate the efficacy and safety of P2Y12 inhibitors and aspirin in patients also receiving anticoagulant therapy.
Methods:
We evaluated patients from the Atrial Fibrillation and Ischaemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial who received rivaroxaban plus an antiplatelet agent; the choice of antiplatelet agent was left to the physician's discretion. The primary efficacy and safety end points, consistent with those of the AFIRE trial, were compared between P2Y12 inhibitors and aspirin groups. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularisation or death from any cause. The primary safety end point was major bleeding according to the International Society on Thrombosis and Haemostasis criteria.
Results:
A total of 1075 patients were included (P2Y12 inhibitor group, n=297; aspirin group, n=778). Approximately 60% of patients were administered proton pump inhibitors (PPIs) and there was no significant difference in PPI use in the groups. There were no significant differences in the primary end points between the groups (efficacy: HR 1.31; 95% CI 0.88 to 1.94; p=0.178; safety: HR 0.79; 95% CI 0.43 to 1.47; p=0.456).
Conclusions:
There were no significant differences in cardiovascular and bleeding events in patients with AF and stable CAD taking rivaroxaban with P2Y12 inhibitors or aspirin in the chronic phase.
Trial Registration Number:
UMIN000016612; NCT02642419.
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