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Antithrombotic Ther...
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Lopes, Renato D.Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA
(author)
Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation
- Article/chapterEnglish2019
Publisher, publication year, extent ...
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MASSACHUSETTS MEDICAL SOC,2019
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LIBRIS-ID:oai:DiVA.org:uu-383192
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-383192URI
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https://doi.org/10.1056/NEJMoa1817083DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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Background Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. Methods 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 P2Y(12) 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. Results 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. Conclusions In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y(12) 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.
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Heizer, GretchenDuke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA
(author)
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Aronson, RonaldBristol Myers Squibb, Princeton, NJ USA
(author)
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Vora, Amit N.Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA
(author)
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Massaro, TylerDuke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA
(author)
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Mehran, RoxanaIcahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA;Cardiovasc Res Fdn, New York, NY USA
(author)
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Goodman, Shaun G.Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada;Univ Toronto, St Michaels Hosp, Terrence Donnelly Heart Ctr, Toronto, ON, Canada
(author)
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Windecker, StephanSwiss Cardiovasc Ctr, Bern, Switzerland
(author)
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Darius, HaraldVivantes Neukoelln Med Ctr, Berlin, Germany
(author)
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Li, JiaBristol Myers Squibb, Princeton, NJ USA
(author)
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Averkov, OlegPirogov Russian Natl Res Med Univ, Moscow, Russia
(author)
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Bahit, M. CeciliaFdn INECO, Inst Neurol Cognit INECO Neurociencias Orono, Rosario, Santa Fe, Argentina
(author)
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Berwanger, OtavioHosp Israelita Albert Einstein, Sao Paulo, Brazil
(author)
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Budaj, AndrzejGrochowski Hosp, Postgrad Med Sch, Warsaw, Poland
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Hijazi, ZiadUppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)ziahi940
(author)
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Parkhomenko, AlexanderStrazhesko Inst Cardiol, Natl Sci Ctr, Kiev, Ukraine
(author)
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Sinnaeve, PeterUniv Leuven, Univ Hosp Leuven, Leuven, Belgium
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Storey, Robert F.Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Sheffield, S Yorkshire, England
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Thiele, HolgerUniv Leipzig, Dept Internal Med Cardiol, Heart Ctr Leipzig, Leipzig, Germany
(author)
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Vinereanu, DragosUniv Med & Pharm Carol Davila, Univ & Emergency Hosp, Bucharest, Romania
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Granger, Christopher B.Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA
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Alexander, John H.Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA
(author)
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Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USABristol Myers Squibb, Princeton, NJ USA
(creator_code:org_t)
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In:New England Journal of Medicine: MASSACHUSETTS MEDICAL SOC380:16, s. 1509-15240028-47931533-4406
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Lopes, Renato D.
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Heizer, Gretchen
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Aronson, Ronald
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Vora, Amit N.
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Massaro, Tyler
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Mehran, Roxana
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Goodman, Shaun G ...
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Windecker, Steph ...
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Darius, Harald
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Li, Jia
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Averkov, Oleg
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Bahit, M. Cecili ...
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Berwanger, Otavi ...
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Budaj, Andrzej
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Hijazi, Ziad
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Parkhomenko, Ale ...
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Sinnaeve, Peter
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Storey, Robert F ...
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Thiele, Holger
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Vinereanu, Drago ...
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