Hospitalization among Patients with Atrial Fibrillation and a Recent Acute Coronary Syndrome or Percutaneous Coronary Intervention Treated with Apixaban or Aspirin: Insights from the AUGUSTUS Trial.

Abstract

The optimal antithrombotic therapy among patients with atrial fibrillation (AF) who present with acute coronary syndrome (ACS) or require percutaneous coronary intervention (PCI) can be challenging, with combination therapy including both dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC) markedly increasing bleeding risk.1 Recent trials with rivaroxaban2 and dabigatran3 have demonstrated the safety of using a non-vitamin K oral anticoagulant (NOAC) with a P2Y12 inhibitor, without aspirin or with reduced-dose aspirin, after PCI. The AUGUSTUS study demonstrated that apixaban resulted in less bleeding than vitamin K antagonist (VKA), with lower rates of the composite of death or all-cause hospitalization.4 Rates of bleeding were higher among patients treated with aspirin than with placebo, but rates of death or all-cause hospitalization were not different. This analysis evaluated rates and causes ofhospitalization, a key secondary outcome, overall and by randomized treatment.