Naslov
Stroke prevention in NVAF patients: where are we now?

Autori
Zaputović, Luka

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, pp prezentacija, znanstveni

Izvornik
CroEcho 2019. 10th Croatian Biennal Echocardiography Congress with International Participation. Programme. / - , 2019

Skup
CroEcho 2019. 10th Croatian Biennal Echocardiography Congress with International Participation

Mjesto i datum
Poreč, Hrvatska, 16.05.2019. - 18.05.2019

Vrsta sudjelovanja
Plenarno

Vrsta recenzije
Međunarodna recenzija

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

Sažetak
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.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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