Risk/Benefit Tradeoff of Antithrombotic Therapy in Patients With Atrial Fibrillation Early and Late After an Acute Coronary Syndrome or Percutaneous Coronary Intervention: Insights From AUGUSTUS
Authors' conclusion
Use of aspirin immediately and for up to 30 days results in an equal tradeoff between an increase in severe bleeding and a reduction in severe ischemic events. After 30 days, aspirin continues to increase bleeding without significantly reducing ischemic events.
Study context
- Population
- Patients with AF and recent ACS or PCI on a P2Y12 inhibitor
- Participants
- 4,614 patients
- Comparison
- Apixaban vs vitamin K antagonist (VKA) and aspirin vs placebo, early and late
- Primary endpoint
- Risk of 3 composite bleeding and 3 composite ischemic outcomes
- Follow-up
- Randomization through 30 days and 30 days to 6 months
Methodological detailspost hoc analysis, 2×2 factorial, open-label (apixaban vs VKA), blinded (aspirin vs placebo)
- Post hoc analysis
- 2×2 factorial
- Open-label (apixaban vs VKA)
- Blinded (aspirin vs placebo)
Primary result
As reported in the abstract
Aspirin vs PlaceboAbsolute risk difference (95% CI)
Severe bleeding, randomization to 30 days
0.97%(0.23–1.70)
Severe ischemic events, randomization to 30 days
−0.91%(−1.74 to −0.08)
Severe bleeding, 30 days to 6 months
1.25%(0.23–2.27)
Severe ischemic events, 30 days to 6 months
−0.17%(−1.33 to 0.98)
Original publication
Risk/Benefit Tradeoff of Antithrombotic Therapy in Patients With Atrial Fibrillation Early and Late After an Acute Coronary Syndrome or Percutaneous Coronary Intervention: Insights From AUGUSTUS. Circulation. Published 29 March 2020. doi:10.
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