engleski

Stroke prevention in NVAF patients: where are we now?

AF is highly prevalent and is a major cause of stroke. In line with ESC 2016 recommendations, for AF patients without contra-indication for NOAC, a NOAC is recommended in preference to a vitamin K antagonist (VKA). Apixaban was associated with a significantly lower risk of stroke and major bleeding in ARISTOTLE trial. Data from clinical practice (RWD) with apixaban are consistent with randomized clinical study results. 5-8% of pts undergoing PCI have AF and 25% of pts with AF will undergo PCI. Combined triple therapy (OAC+aspirin+P2Y12) significantly increases the risk of bleeding. Studies with other NOACs (RE-DUAL PCI with dabigatran and PIONEER-AF PCI with rivaroxaban) have shown reduced risk of bleeding in combination therapy when compared to warfarin. Recently published AUGUSTUS trial was prospective, multicenter, two-by-two factorial RCT. Patients with AF who had a recent ACS or underwent PCI (or both) were randomized to apixaban 5 mg BID vs. VKA, and then to aspirin vs. placebo. In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor (mainly clopidogrel), an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in ischemic events than regimens that included a vitamin K antagonist, aspirin, or both. The risk of bleeding was significantly higher with aspirin in combination with either anticoagulants in combination with P2Y12 inhibitor, compared to P2Y12 inhibitor plus anticoagulant without aspirin.

non-valvular atrial fibrillation, acute coronary syndrome, percutaneous coronary intervention, antithrombotic treatment

nije evidentirano