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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

Antithrombotic therapy to minimize total events after ACS or PCI in atrial fibrillation: insights from AUGUSTUS

Seung Hun Lee1,2, Jennifer A Rymer1, W Schuyler Jones1

  • 1Division of Cardiology, Department of Medicine, Duke University Health System, Durham, North Carolina, USA.

Current Opinion in Cardiology
|August 19, 2026
PubMed

Insights

Dual antithrombotic therapy with direct oral anticoagulants (DOAC) and a P2Y12 inhibitor is recommended for atrial fibrillation (AF) patients post-acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI). This approach balances stroke prevention and bleeding risk effectively.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Balancing antithrombotic therapy for stroke and bleeding in atrial fibrillation (AF) patients after acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) is critical.
  • Recent analyses reframe treatment benefits beyond initial events, necessitating updated therapeutic strategies.

Purpose of the Study:

  • To review current antithrombotic strategies for AF patients following ACS or PCI.
  • To evaluate the safety and efficacy of direct oral anticoagulants (DOACs) in this patient population.

Main Methods:

  • Review of four dedicated trials investigating dual antithrombotic therapy (DOAC plus P2Y12 inhibitor with early aspirin withdrawal).
  • Analysis of recent recurrent-event and patient-centered data, including the AUGUSTUS trial.

Main Results:

  • Dual therapy with DOACs and P2Y12 inhibitors, with early aspirin withdrawal, reduces bleeding without significantly increasing ischemic events.
  • Aspirin-free strategies require careful consideration based on anticoagulation status; oral anticoagulation may substitute for early aspirin's role in AF patients.
  • The AUGUSTUS trial demonstrated reduced bleeding with apixaban compared to vitamin K antagonists, and significantly less bleeding with placebo compared to aspirin.

Conclusions:

  • DOAC-based dual antithrombotic therapy offers the optimal safety-efficacy balance for AF patients post-ACS or PCI.
  • Future research should investigate optimal aspirin discontinuation timing and recurrent-event endpoints.
Abstract

Keywords:
acute coronary syndromeantithrombotic therapyatrial fibrillationpercutaneous coronary interventionrecurrent events

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