Apixaban and Limiting Aspirin for Patients With Atrial Fibrillation, Percutaneous Coronary Intervention, and Multimorbidity
Authors' conclusion
Our findings support the standard use of apixaban plus a P2Y12 inhibitor in patients with AF and ACS/PCI, irrespective of the presence of multimorbidity.
Study context
- Population
- Patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) treated with a P2Y12 inhibitor97.4% with comorbidity data
- Participants
- 4,493 patients
- Comparison
- Multimorbidity categories; apixaban vs vitamin K antagonists (VKA) and aspirin vs placebo across multimorbidity
- No multimorbidityn = 1,897reference
- Moderate multimorbidityn = 2,110
- High multimorbidityn = 486
Methodological details2 × 2 factorial, apixaban vs VKA open-label, aspirin vs placebo double-blind
- 2 × 2 factorial
- Apixaban vs VKA open-label
- Aspirin vs placebo double-blind
Primary result
As reported in the abstract
ISTH major or CRNM bleeding
Each group vs no multimorbidityHazard ratio (95% CI)
Moderate multimorbidity
1.23(1.02–1.47)
High multimorbidity
1.98(1.55–2.54)
Further findings
Interaction of multimorbidity with apixaban vs VKA
- International Society on Thrombosis and Haemostasis (ISTH) major bleeding/clinically relevant nonmajor (CRNM): no significant interaction
- P int = 0.415
- Death or hospitalization: no significant interaction
- P int = 0.092
- Death or ischemic event: no significant interaction
- P int = 0.299
Interaction of multimorbidity with aspirin vs placebo
- ISTH major bleeding/CRNM: no significant interaction
- P int = 0.261
- Death or hospitalization: no significant interaction
- P int = 0.646
- Death or ischemic event: no significant interaction
- P int = 0.608
Original publication
Apixaban and Limiting Aspirin for Patients With Atrial Fibrillation, Percutaneous Coronary Intervention, and Multimorbidity. JACC Adv. Published 17 October 2024. doi:10.
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