Coronary disease & ACSSecondary analysis
Risk/Benefit Tradeoff of Antithrombotic Therapy in Patients With Atrial Fibrillation Early and Late After an Acute Coronary Syndrome or Percutaneous Coronary Intervention
- Secondary analysis of the AUGUSTUS randomised trial
- post hoc analysis
- 2×2 factorial
- open-label (apixaban vs vitamin K antagonist (VKA))
- blinded (aspirin vs placebo)
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 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
Primary result
As reported in the abstract
Severe bleeding and severe ischemic events, aspirin vs placebo
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. Circulation. Published 29 March 2020. doi:10.1161/circulationaha.120.046534
Summarised from the published abstract; every number is checked against it