@article{8b84ac18f3c746a6914e255ca5289521,
title = "Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation",
abstract = "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 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. 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 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.",
keywords = "Antithrombotic Therapy, Acute Coronary Syndrome, percutaneous coronary intervention, Atrial Fibrillation",
author = "Lopes, {Renato D.} and Gretchen Heizer and Ronald Aronson and Vora, {Amit N.} and Tyler Massaro and Roxana Mehran and Goodman, {Shaun G.} and Stephan Windecker and Harald Darius and Jia Li and Oleg Averkov and Bahit, {M. Cecilia} and Otavio Berwanger and Andrzej Budaj and Ziad Hijazi and Alexander Parkhomenko and Peter Sinnaeve and Storey, {Robert F.} and Holger Thiele and Dragos Vinereanu and Granger, {Christopher B.} and Alexander, {John H.} and {AUGUSTUS Investigators} and Hrabar, {A. D.} and A. Caccavo and A. Licheri and Alvarisqueta, {A. F.} and Abud, {A. M.} and C. Estrada and Sueldo, {C. P.} and E. Montenegro and Duronto, {E. A.} and Blanco, {F. L.} and Berra, {F. C.} and {Ferr{\'e} P{\'a}cora}, {F. A.} and Lopez, {G. M.} and G. Calvo and Azize, {G. M.} and Luquez, {H. A.} and H. Ramos and Colombo, {H. R.} and Guetta, {J. N.} and Resk, {J. H.} and Medrano, {J. C.} and Costabel, {J. P.} and J. Carbajales and Schiavi, {L. B.} and Saggia, {L. I.} and Oliva, {M. A.} and M. Casas and M. Snitman and {Litvak Bruno}, {M. R.} and N. Cluigt and Vita, {N. A.} and Guzman, {P. N.} and Zangroniz, {P. D.} and Villarreal, {R. A.} and Bonato, {R. R.} and S. Nani and Sassone, {S. A.} and Macin, {S. M.} and Arias, {V. E.} and C. Alexopoulos and D. Brieger and D. Colquhoun and Heddle, {W. F.} and A. Podczeck-Schweighofer and C. Ebner and D. Scherr and Lang, {I. M.} and K. Huber and A. Guedes and C. Convens and F. Cools and J. Vercammen and J. Bartunek and T. Rossenbacker and Pereira, {A. H.} and Kormann, {A. M.} and Freitas, {A. F.} and Fonseca, {A. G. T.} and {de Quadros}, A. and Janella, {B. L.} and Kalil, {C. A.A.} and Rodrigues, {C. S.} and Precoma, {D. B.} and E. Ramacciotti and Resende, {E. S.} and Figueiredo, {E. L.} and Manenti, {E. R.} and Costa, {F. A.D.} and G. Feitosa and Reis, {H. J.L.} and Ribeiro, {H. B.} and {de Moraes}, {J. B.M.X.} and Dantas, {J. M.M.} and Nicolau, {J. C.} and Saraiva, {J. F.K.} and J. Reol{\~a}o and Piegas, {L. S.} and Oliveira, {L. F.A.} and Ritt, {L. E.F.} and Braile, {M. C.V.B.} and Dracoulakis, {M. A.} and {de Santos}, {M. O.N.} and Le{\~a}es, {P. E.} and Filho, {P. P.} and Rech, {R. L.} and R. Ueda and Silvestrini, {T. L.} and Michalaros, {Y. L.} and A. Manolova and Mihov, {A. K.} and B. Yatseva and C. Velikov and Raev, {D. H.} and D. Markov and D. Vassilev and E. Georgiev and Benov, {H. O.} and I. Daskalov and Petrov, {I. P.} and M. Milanova and Shehova-Yankova, {N. S.} and Lazov, {P. V.} and S. Beleva and Marchev, {S. T.} and Gelev, {V. L.} and B. Tyrrell and B. Wong and D. Dion and D. LaFlamme and Rupka, {D. W.} and D. Shukla and E. Sabbah and Nadra, {I. J.} and I. Bata and Cherry, {J. M.} and O. Toleva and P. Dehghani and R. Vijayaraghavan and R. Welsh and R. Bagur and Labonte, {R. E.} and S. Vizel and S. Fort and T. Huynh and Quan, {V. H.} and Y. Pesant and D. Isaza and {Accini Mendoza}, {J. L.} and Gomez, {J. E.} and {Jaramillo Gomez}, {N. I.} and A. Knezevic and A. Ruzic and D. Horvat and D. Milicic and K. Selthofer-Relatic and K. Pesek and Pravecek, {M. K.} and M. Kovacic and S. Manola and V. Persic and D. Alan and J. Belohlavek and Larsen, {C. T.} and J. Br{\o}nnum-Schou and Veien, {K. T.} and Christensen, {L. S.} and M. Maeng and R. Steffensen and D. Angoulvant and F. Beygui and G. Range and G. Cayla and Aupetit, {J. F.} and M. Elbaz and N. Delarche and N. Meneveau and A. Ghanem and A. Hagendorff and A. Wilke and A. Hummel and C. Axthelm and C. Kadel and C. Langer and C. Stellbrink and C. Jacobshagen and Gross, {C. M.} and Blessing, {E. E.B.} and Minden, {H. H.} and H. Bogossian and H. Wienbergen and H. Ebelt and H. Dreger and H. Ince and I. Akin and I. Eitel and I. Kreis and Appel, {K. F.} and L. Maier and M. Bergmann and M. Moser and N. Toursarkissian and N. Menck and O. Ritter and P. Bernhardt and P. Nordbeck and R. St{\"o}hring and R. Schwinger and Braun-Dullaeus, {R. C.} and Maier, {S. K.G.} and S. Schellong and S. Steiner and T. Rudolph and Dengler, {T. J.} and T. Geisler and U. Rauch-Kr{\"o}hnert and W. Jung and W. Jungmair and A. Kom{\'o}csi and A. Papp and A. V{\'e}rtes and A. Moh{\'a}csi and B. Herczeg and B. Merkely and D{\'e}zsi, {C. A.} and E. Kis and F. Lakatos and G. Kerecsen and Piros, {G. A.} and J. Tak{\'a}cs and Lee, {C. W.} and S. Oh and V. Kuznetsov and J. Jensen and J. Andersson and Fischer, {T. A.} and Francis, {C. M.} and C. Barr and J. Irving and J. Mills and T. Levy and Martin, {A. C.} and Duffy, {B. K.} and Abbott, {J. D.} and Strobel, {J. S.} and Foster, {M. T.} and King, {M. Y.} and P. Singh and Jones, {S. E.}",
year = "2019",
doi = "10.1056/NEJMoa1817083",
language = "English",
volume = "380",
pages = "1509--1524",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachusetts Medical Society",
number = "16",
}