Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation

Renato D. Lopes, Gretchen Heizer, Ronald Aronson, Amit N. Vora, Tyler Massaro, Roxana Mehran, Shaun G. Goodman, Stephan Windecker, Harald Darius, Jia Li, Oleg Averkov, M. Cecilia Bahit, Otavio Berwanger, Andrzej Budaj, Ziad Hijazi, Alexander Parkhomenko, Peter Sinnaeve, Robert F. Storey, Holger Thiele, Dragos Vinereanu & 486 others Christopher B. Granger, John H. Alexander, A. D. Hrabar, A. Caccavo, A. Licheri, A. F. Alvarisqueta, A. M. Abud, C. Estrada, C. P. Sueldo, E. Montenegro, E. A. Duronto, F. L. Blanco, F. C. Berra, F. A. Ferré Pácora, G. M. Lopez, G. Calvo, G. M. Azize, H. A. Luquez, H. Ramos, H. R. Colombo, J. N. Guetta, J. H. Resk, J. C. Medrano, J. P. Costabel, J. Carbajales, L. B. Schiavi, L. I. Saggia, M. A. Oliva, M. Casas, M. Snitman, M. R. Litvak Bruno, N. Cluigt, N. A. Vita, P. N. Guzman, P. D. Zangroniz, R. A. Villarreal, R. R. Bonato, S. Nani, S. A. Sassone, S. M. Macin, V. E. Arias, C. Alexopoulos, D. Brieger, D. Colquhoun, W. F. Heddle, A. Podczeck-Schweighofer, C. Ebner, D. Scherr, I. M. Lang, K. Huber, A. Guedes, C. Convens, F. Cools, J. Vercammen, J. Bartunek, T. Rossenbacker, A. H. Pereira, A. M. Kormann, A. F. Freitas, A. G.T. Fonseca, A. de Quadros, B. L. Janella, C. A.A. Kalil, C. S. Rodrigues, D. B. Precoma, E. Ramacciotti, E. S. Resende, E. L. Figueiredo, E. R. Manenti, F. A.D. Costa, G. Feitosa, H. J.L. Reis, H. B. Ribeiro, J. B.M.X. de Moraes, J. M.M. Dantas, J. C. Nicolau, J. F.K. Saraiva, J. Reolão, L. S. Piegas, L. F.A. Oliveira, L. E.F. Ritt, M. C.V.B. Braile, M. A. Dracoulakis, M. O.N. de Santos, P. E. Leães, P. P. Filho, R. L. Rech, R. Ueda, T. L. Silvestrini, Y. L. Michalaros, A. Manolova, A. K. Mihov, B. Yatseva, C. Velikov, D. H. Raev, D. Markov, D. Vassilev, E. Georgiev, H. O. Benov, I. Daskalov, I. P. Petrov, M. Milanova, N. S. Shehova-Yankova, P. V. Lazov, S. Beleva, S. T. Marchev, V. L. Gelev, B. Tyrrell, B. Wong, D. Dion, D. LaFlamme, D. W. Rupka, D. Shukla, E. Sabbah, I. J. Nadra, I. Bata, J. M. Cherry, O. Toleva, P. Dehghani, R. Vijayaraghavan, R. Welsh, R. Bagur, R. E. Labonte, S. Vizel, S. Fort, T. Huynh, V. H. Quan, Y. Pesant, D. Isaza, J. L. Accini Mendoza, J. E. Gomez, N. I. Jaramillo Gomez, A. Knezevic, A. Ruzic, D. Horvat, D. Milicic, K. Selthofer-Relatic, K. Pesek, M. K. Pravecek, M. Kovacic, S. Manola, V. Persic, D. Alan, J. Belohlavek, C. T. Larsen, J. Brønnum-Schou, K. T. Veien, L. S. Christensen, M. Maeng, R. Steffensen, D. Angoulvant, F. Beygui, G. Range, G. Cayla, J. F. Aupetit, M. Elbaz, N. Delarche, N. Meneveau, A. Ghanem, A. Hagendorff, A. Wilke, A. Hummel, C. Axthelm, C. Kadel, C. Langer, C. Stellbrink, C. Jacobshagen, C. M. Gross, E. E.B. Blessing, H. H. Minden, H. Bogossian, H. Wienbergen, H. Ebelt, H. Dreger, H. Ince, I. Akin, I. Eitel, I. Kreis, K. F. Appel, L. Maier, M. Bergmann, M. Moser, N. Toursarkissian, N. Menck, O. Ritter, P. Bernhardt, P. Nordbeck, R. Stöhring, R. Schwinger, R. C. Braun-Dullaeus, S. K.G. Maier, S. Schellong, S. Steiner, T. Rudolph, T. J. Dengler, T. Geisler, U. Rauch-Kröhnert, W. Jung, W. Jungmair, A. Komócsi, A. Papp, A. Vértes, A. Mohácsi, B. Herczeg, B. Merkely, C. A. Dézsi, E. Kis, F. Lakatos, G. Kerecsen, G. A. Piros, J. Takács, J. Tomcsányi, K. Keltai, Z. Kovács, A. Mathur, H. A. Baxi, J. Narendra, J. Gupta, M. Kumbla, N. K. Jamwal, P. Arora, A. Katz, A. Shotan, E. Schiff, N. A. Freedberg, O. Amir, O. Hussein, O. H. Kracoff, R. Alcalai, S. Y. Adawi, S. Viskin, T. Hayek, Y. Hasin, Y. Rozenman, C. W. Nam, C. W. Lee, D. J. Choi, D. S. Jeon, H. W. Park, J. W. Son, J. O. Jeong, K. S. Cha, S. Oh, Seung-Woon Rha, Y. H. Park, Y. K. On, A. E. Bazzoni Ruiz, A. R. Valdespino, B. E. Castro Montes, G. A. Ramos Lopez, G. A. Llamas Esperón, G. Solache, J. S. Macías García, J. L. Leiva-Pons, M. O. De Los Rios Ibarra, F. F. Willems, H. P. Beyerbacht, R. van de Wal, J. Hysing, K. T. Lappegard, L. E. Vinge, S. Halvorsen, V. Pönitz, C. A. Chavez Ayala, F. A. Medina Palomino, J. C. Garcia Matheus, A. Włodarczak, A. Lubinski, D. Czarnecka, D. Wojciechowski, G. Skonieczny, J. D. Kasprzak, J. K. Wranicz, J. Szachniewicz, K. K. Kincel, K. Zmudka, M. Lesiak, M. Piekarski, M. Wujkowski, M. Lica-Gorzynska, P. Miekus, P. Feusette, R. Bartkowiak, R. Korzeniak, W. Sinkiewicz, W. Musial, Z. Krolikowski, A. Gaspar, F. Pinto, F. Almeida, J. Martinez, L. Brandão, L. M. Santos, P. Mateus, P. Monteiro, S. Pernencar, C. Mornoş, D. M. Olinic, D. T. Zdrenghea, F. O. Ortan, M. Cinteza, M. Popescu, O. Voicu, S. B.F. Todea, V. Babes, A. Y. Vishnevskiy, A. D. Kuimov, D. V. Duplyakov, E. Kosmacheva, E. Pokushalov, I. G. Gordeev, K. N. Zrazhevskiy, L. A. Sorokin, L. G. Ermoshkina, M. V. Zykov, M. Y. Ruda, O. Bulashova, O. G. Smolenskaya, O. V. Orlikova, S. L. Grishaev, S. V. Shalaev, S. A. Boldueva, V. Kuznetsov, V. Makukhin, V. Kostenko, Y. Shvarts, Z. D. Kobalava, A. Selakovic, B. P. Tosic, D. B. Sakac, M. Pavlovic, M. Dekleva, N. M. Tasic, S. Hinic, T. Jozic, T. Potpara, A. Dzupina, D. Pella, I. Majercak, I. Striezova, J. Fedacko, J. Gonsorcik, J. Fecik, J. Selecky, L. Antalik, M. Hranai, M. Gocar, M. Kokles, R. Oriesek, A. Regueiro, B. Ibánez, D. P. Djurovic, E. Gutierrez Ibañes, F. Ridocci-Soriano, J. Diaz Fernandez, J. J. Artaecheverria Zuazo, J. M. Escudier Villa, J. Nuñez Villota, M. Sanmartin Fernandez, P. A. Chinchurreta Capote, R. Muñoz Aguilera, T. Vera Ripoll, V. Mainar Tello, F. Björklund, J. Jensen, J. Andersson, J. Lauermann, M. Hamid, O. Angerås, T. A. Fischer, A. V. Yagensky, B. I. Goloborodko, I. I. Kyrychenko, I. P. Vakaliuk, I. Kovalskyy, M. V. Rishko, N. Sydor, O. I. Karpenko, O. M. Parkhomenko, O. A. Koval, O. Godlevska, S. Zhurba, V. Y. Maslovskyi, V. Z. Netiazhenko, V. K. Tashchuk, V. P. Shcherbak, V. I. Tseluyko, A. Cooke, B. Wrigley, C. M. Francis, C. Barr, D. A. Gorog, G. Y.H. Lip, J. Irving, J. Mills, T. Levy, A. A. Cheema, A. S. Salacata, A. N. Tenaglia, A. W. Meholick, A. R. Vedere, A. J. Patrello, A. Spaedy, A. C. Martin, B. H. Holland, B. K. Duffy, B. Schuler, C. B. Treasure, C. Paraboschi, C. A. Pickett, C. J. Rowan, C. R. Longnecker, C. N. Hess, D. A. Hinchman, D. J. Schneider, D. K. Murdock, D. E. Baldwin, E. A. Flores, E. J. Sirulnick, F. Ahmad, G. Aggarwala, G. Dhar, G. M. Kichura, G. Turitto, G. C. Sampognaro, G. K. Sharma, H. Chandna, H. T.D. Truong, J. Poock, J. S. Walia, J. T. Zelenka, J. K. Amin, J. Foucauld, J. Chambers, J. D. Abbott, J. S. Strobel, J. R. Dy, K. A. Nour, L. E. Sullenberger, L. T. Younis, L. Gonzales, M. Chane, M. T. Foster, M. Y. King, M. A. Grabarczyk, M. R. Izzo, M. A. Leesar, M. A. Bernabei, M. D. Cavender, M. J. Janik, M. Buchbinder, M. Arcarese, M. Yeh, M. J. Sheth, M. C. Sinno, M. F. Shoukfeh, M. Alhaddad, N. V. Ranadive, N. A. Jaffrani, N. K. Little, N. Shammas, N. A. Assi, O. Almousalli, P. Chan, P. A. Horwitz, P. A. Rozeman, P. Singh, R. Aggarwal, R. Gopinathannair, R. Manshadi, R. Korabathina, R. M. Gilmore, R. B. Feldman, R. N. Schnitzler, R. W. Harrison, S. N. Gandhi, S. Graham, S. K. Krueger, S. E. Jones, S. K. Rowe, S. B. Bazaz, T. M. Haddad, T. J. Povsic, U. A. Badami, W. B. Abernethy, Z. A. Mirza

Research output: Contribution to journal › Article

39 Citations (Scopus)

Abstract

BACKGROUND Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. METHODS In an international trial with a two-by-two factorial design, we randomly assigned patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y12 inhibitor to receive apixaban or a Vitamin K antagonist and to receive aspirin or matching placebo for 6 months. The primary outcome was major or clinically relevant nonmajor bleeding. Secondary outcomes included death or hospitalization and a composite of ischemic events. RESULTS Enrollment included 4614 patients from 33 countries. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. Major or clinically relevant nonmajor bleeding was noted in 10.5% of the patients receiving apixaban, as compared with 14.7% of those receiving a Vitamin K antagonist (hazard ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.81; P<0.001 for both noninferiority and superiority), and in 16.1% of the patients receiving aspirin, as compared with 9.0% of those receiving placebo (hazard ratio, 1.89; 95% CI, 1.59 to 2.24; P<0.001). Patients in the apixaban group had a lower incidence of death or hospitalization than those in the Vitamin K antagonist group (23.5% vs. 27.4%; hazard ratio, 0.83; 95% CI, 0.74 to 0.93; P = 0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group. CONCLUSIONS In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a Vitamin K antagonist, aspirin, or both.

Original languageEnglish
Pages (from-to)1509-1524
Number of pages16
JournalNew England Journal of Medicine
Volume380
Issue number16
DOIs
Publication statusPublished - 2019 Apr 18

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Percutaneous Coronary Intervention
Acute Coronary Syndrome
Atrial Fibrillation
Vitamin K
Aspirin
Hospitalization
Incidence
Placebos
Confidence Intervals
Therapeutics
Hemorrhage
Random Allocation
apixaban

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lopes, R. D., Heizer, G., Aronson, R., Vora, A. N., Massaro, T., Mehran, R., ... Mirza, Z. A. (2019). Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. New England Journal of Medicine, 380(16), 1509-1524. https://doi.org/10.1056/NEJMoa1817083

Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. / Lopes, Renato D.; Heizer, Gretchen; Aronson, Ronald; Vora, Amit N.; Massaro, Tyler; Mehran, Roxana; Goodman, Shaun G.; Windecker, Stephan; Darius, Harald; Li, Jia; Averkov, Oleg; Bahit, M. Cecilia; Berwanger, Otavio; Budaj, Andrzej; Hijazi, Ziad; Parkhomenko, Alexander; Sinnaeve, Peter; Storey, Robert F.; Thiele, Holger; Vinereanu, Dragos; Granger, Christopher B.; Alexander, John H.; Hrabar, A. D.; Caccavo, A.; Licheri, A.; Alvarisqueta, A. F.; Abud, A. M.; Estrada, C.; Sueldo, C. P.; Montenegro, E.; Duronto, E. A.; Blanco, F. L.; Berra, F. C.; Ferré Pácora, F. A.; Lopez, G. M.; Calvo, G.; Azize, G. M.; Luquez, H. A.; Ramos, H.; Colombo, H. R.; Guetta, J. N.; Resk, J. H.; Medrano, J. C.; Costabel, J. P.; Carbajales, J.; Schiavi, L. B.; Saggia, L. I.; Oliva, M. A.; Casas, M.; Snitman, M.; Litvak Bruno, M. R.; Cluigt, N.; Vita, N. A.; Guzman, P. N.; Zangroniz, P. D.; Villarreal, R. A.; Bonato, R. R.; Nani, S.; Sassone, S. A.; Macin, S. M.; Arias, V. E.; Alexopoulos, C.; Brieger, D.; Colquhoun, D.; Heddle, W. F.; Podczeck-Schweighofer, A.; Ebner, C.; Scherr, D.; Lang, I. M.; Huber, K.; Guedes, A.; Convens, C.; Cools, F.; Vercammen, J.; Bartunek, J.; Rossenbacker, T.; Pereira, A. H.; Kormann, A. M.; Freitas, A. F.; Fonseca, A. G.T.; de Quadros, A.; Janella, B. L.; Kalil, C. A.A.; Rodrigues, C. S.; Precoma, D. B.; Ramacciotti, E.; Resende, E. S.; Figueiredo, E. L.; Manenti, E. R.; Costa, F. A.D.; Feitosa, G.; Reis, H. J.L.; Ribeiro, H. B.; de Moraes, J. B.M.X.; Dantas, J. M.M.; Nicolau, J. C.; Saraiva, J. F.K.; Reolão, J.; Piegas, L. S.; Oliveira, L. F.A.; Ritt, L. E.F.; Braile, M. C.V.B.; Dracoulakis, M. A.; de Santos, M. O.N.; Leães, P. E.; Filho, P. P.; Rech, R. L.; Ueda, R.; Silvestrini, T. L.; Michalaros, Y. L.; Manolova, A.; Mihov, A. K.; Yatseva, B.; Velikov, C.; Raev, D. H.; Markov, D.; Vassilev, D.; Georgiev, E.; Benov, H. O.; Daskalov, I.; Petrov, I. P.; Milanova, M.; Shehova-Yankova, N. S.; Lazov, P. V.; Beleva, S.; Marchev, S. T.; Gelev, V. L.; Tyrrell, B.; Wong, B.; Dion, D.; LaFlamme, D.; Rupka, D. W.; Shukla, D.; Sabbah, E.; Nadra, I. J.; Bata, I.; Cherry, J. M.; Toleva, O.; Dehghani, P.; Vijayaraghavan, R.; Welsh, R.; Bagur, R.; Labonte, R. E.; Vizel, S.; Fort, S.; Huynh, T.; Quan, V. H.; Pesant, Y.; Isaza, D.; Accini Mendoza, J. L.; Gomez, J. E.; Jaramillo Gomez, N. I.; Knezevic, A.; Ruzic, A.; Horvat, D.; Milicic, D.; Selthofer-Relatic, K.; Pesek, K.; Pravecek, M. K.; Kovacic, M.; Manola, S.; Persic, V.; Alan, D.; Belohlavek, J.; Larsen, C. T.; Brønnum-Schou, J.; Veien, K. T.; Christensen, L. S.; Maeng, M.; Steffensen, R.; Angoulvant, D.; Beygui, F.; Range, G.; Cayla, G.; Aupetit, J. F.; Elbaz, M.; Delarche, N.; Meneveau, N.; Ghanem, A.; Hagendorff, A.; Wilke, A.; Hummel, A.; Axthelm, C.; Kadel, C.; Langer, C.; Stellbrink, C.; Jacobshagen, C.; Gross, C. M.; Blessing, E. E.B.; Minden, H. H.; Bogossian, H.; Wienbergen, H.; Ebelt, H.; Dreger, H.; Ince, H.; Akin, I.; Eitel, I.; Kreis, I.; Appel, K. F.; Maier, L.; Bergmann, M.; Moser, M.; Toursarkissian, N.; Menck, N.; Ritter, O.; Bernhardt, P.; Nordbeck, P.; Stöhring, R.; Schwinger, R.; Braun-Dullaeus, R. C.; Maier, S. K.G.; Schellong, S.; Steiner, S.; Rudolph, T.; Dengler, T. J.; Geisler, T.; Rauch-Kröhnert, U.; Jung, W.; Jungmair, W.; Komócsi, A.; Papp, A.; Vértes, A.; Mohácsi, A.; Herczeg, B.; Merkely, B.; Dézsi, C. A.; Kis, E.; Lakatos, F.; Kerecsen, G.; Piros, G. A.; Takács, J.; Tomcsányi, J.; Keltai, K.; Kovács, Z.; Mathur, A.; Baxi, H. A.; Narendra, J.; Gupta, J.; Kumbla, M.; Jamwal, N. K.; Arora, P.; Katz, A.; Shotan, A.; Schiff, E.; Freedberg, N. A.; Amir, O.; Hussein, O.; Kracoff, O. H.; Alcalai, R.; Adawi, S. Y.; Viskin, S.; Hayek, T.; Hasin, Y.; Rozenman, Y.; Nam, C. W.; Lee, C. W.; Choi, D. J.; Jeon, D. S.; Park, H. W.; Son, J. W.; Jeong, J. O.; Cha, K. S.; Oh, S.; Rha, Seung-Woon; Park, Y. H.; On, Y. K.; Bazzoni Ruiz, A. E.; Valdespino, A. R.; Castro Montes, B. E.; Ramos Lopez, G. A.; Llamas Esperón, G. A.; Solache, G.; Macías García, J. S.; Leiva-Pons, J. L.; De Los Rios Ibarra, M. O.; Willems, F. F.; Beyerbacht, H. P.; van de Wal, R.; Hysing, J.; Lappegard, K. T.; Vinge, L. E.; Halvorsen, S.; Pönitz, V.; Chavez Ayala, C. A.; Medina Palomino, F. A.; Garcia Matheus, J. C.; Włodarczak, A.; Lubinski, A.; Czarnecka, D.; Wojciechowski, D.; Skonieczny, G.; Kasprzak, J. D.; Wranicz, J. K.; Szachniewicz, J.; Kincel, K. K.; Zmudka, K.; Lesiak, M.; Piekarski, M.; Wujkowski, M.; Lica-Gorzynska, M.; Miekus, P.; Feusette, P.; Bartkowiak, R.; Korzeniak, R.; Sinkiewicz, W.; Musial, W.; Krolikowski, Z.; Gaspar, A.; Pinto, F.; Almeida, F.; Martinez, J.; Brandão, L.; Santos, L. M.; Mateus, P.; Monteiro, P.; Pernencar, S.; Mornoş, C.; Olinic, D. M.; Zdrenghea, D. T.; Ortan, F. O.; Cinteza, M.; Popescu, M.; Voicu, O.; Todea, S. B.F.; Babes, V.; Vishnevskiy, A. Y.; Kuimov, A. D.; Duplyakov, D. V.; Kosmacheva, E.; Pokushalov, E.; Gordeev, I. G.; Zrazhevskiy, K. N.; Sorokin, L. A.; Ermoshkina, L. G.; Zykov, M. V.; Ruda, M. Y.; Bulashova, O.; Smolenskaya, O. G.; Orlikova, O. V.; Grishaev, S. L.; Shalaev, S. V.; Boldueva, S. A.; Kuznetsov, V.; Makukhin, V.; Kostenko, V.; Shvarts, Y.; Kobalava, Z. D.; Selakovic, A.; Tosic, B. P.; Sakac, D. B.; Pavlovic, M.; Dekleva, M.; Tasic, N. M.; Hinic, S.; Jozic, T.; Potpara, T.; Dzupina, A.; Pella, D.; Majercak, I.; Striezova, I.; Fedacko, J.; Gonsorcik, J.; Fecik, J.; Selecky, J.; Antalik, L.; Hranai, M.; Gocar, M.; Kokles, M.; Oriesek, R.; Regueiro, A.; Ibánez, B.; Djurovic, D. P.; Gutierrez Ibañes, E.; Ridocci-Soriano, F.; Diaz Fernandez, J.; Artaecheverria Zuazo, J. J.; Escudier Villa, J. M.; Nuñez Villota, J.; Sanmartin Fernandez, M.; Chinchurreta Capote, P. A.; Muñoz Aguilera, R.; Vera Ripoll, T.; Mainar Tello, V.; Björklund, F.; Jensen, J.; Andersson, J.; Lauermann, J.; Hamid, M.; Angerås, O.; Fischer, T. A.; Yagensky, A. V.; Goloborodko, B. I.; Kyrychenko, I. I.; Vakaliuk, I. P.; Kovalskyy, I.; Rishko, M. V.; Sydor, N.; Karpenko, O. I.; Parkhomenko, O. M.; Koval, O. A.; Godlevska, O.; Zhurba, S.; Maslovskyi, V. Y.; Netiazhenko, V. Z.; Tashchuk, V. K.; Shcherbak, V. P.; Tseluyko, V. I.; Cooke, A.; Wrigley, B.; Francis, C. M.; Barr, C.; Gorog, D. A.; Lip, G. Y.H.; Irving, J.; Mills, J.; Levy, T.; Cheema, A. A.; Salacata, A. S.; Tenaglia, A. N.; Meholick, A. W.; Vedere, A. R.; Patrello, A. J.; Spaedy, A.; Martin, A. C.; Holland, B. H.; Duffy, B. K.; Schuler, B.; Treasure, C. B.; Paraboschi, C.; Pickett, C. A.; Rowan, C. J.; Longnecker, C. R.; Hess, C. N.; Hinchman, D. A.; Schneider, D. J.; Murdock, D. K.; Baldwin, D. E.; Flores, E. A.; Sirulnick, E. J.; Ahmad, F.; Aggarwala, G.; Dhar, G.; Kichura, G. M.; Turitto, G.; Sampognaro, G. C.; Sharma, G. K.; Chandna, H.; Truong, H. T.D.; Poock, J.; Walia, J. S.; Zelenka, J. T.; Amin, J. K.; Foucauld, J.; Chambers, J.; Abbott, J. D.; Strobel, J. S.; Dy, J. R.; Nour, K. A.; Sullenberger, L. E.; Younis, L. T.; Gonzales, L.; Chane, M.; Foster, M. T.; King, M. Y.; Grabarczyk, M. A.; Izzo, M. R.; Leesar, M. A.; Bernabei, M. A.; Cavender, M. D.; Janik, M. J.; Buchbinder, M.; Arcarese, M.; Yeh, M.; Sheth, M. J.; Sinno, M. C.; Shoukfeh, M. F.; Alhaddad, M.; Ranadive, N. V.; Jaffrani, N. A.; Little, N. K.; Shammas, N.; Assi, N. A.; Almousalli, O.; Chan, P.; Horwitz, P. A.; Rozeman, P. A.; Singh, P.; Aggarwal, R.; Gopinathannair, R.; Manshadi, R.; Korabathina, R.; Gilmore, R. M.; Feldman, R. B.; Schnitzler, R. N.; Harrison, R. W.; Gandhi, S. N.; Graham, S.; Krueger, S. K.; Jones, S. E.; Rowe, S. K.; Bazaz, S. B.; Haddad, T. M.; Povsic, T. J.; Badami, U. A.; Abernethy, W. B.; Mirza, Z. A.

In: New England Journal of Medicine, Vol. 380, No. 16, 18.04.2019, p. 1509-1524.

Research output: Contribution to journal › Article

Lopes, RD, Heizer, G, Aronson, R, Vora, AN, Massaro, T, Mehran, R, Goodman, SG, Windecker, S, Darius, H, Li, J, Averkov, O, Bahit, MC, Berwanger, O, Budaj, A, Hijazi, Z, Parkhomenko, A, Sinnaeve, P, Storey, RF, Thiele, H, Vinereanu, D, Granger, CB, Alexander, JH, Hrabar, AD, Caccavo, A, Licheri, A, Alvarisqueta, AF, Abud, AM, Estrada, C, Sueldo, CP, Montenegro, E, Duronto, EA, Blanco, FL, Berra, FC, Ferré Pácora, FA, Lopez, GM, Calvo, G, Azize, GM, Luquez, HA, Ramos, H, Colombo, HR, Guetta, JN, Resk, JH, Medrano, JC, Costabel, JP, Carbajales, J, Schiavi, LB, Saggia, LI, Oliva, MA, Casas, M, Snitman, M, Litvak Bruno, MR, Cluigt, N, Vita, NA, Guzman, PN, Zangroniz, PD, Villarreal, RA, Bonato, RR, Nani, S, Sassone, SA, Macin, SM, Arias, VE, Alexopoulos, C, Brieger, D, Colquhoun, D, Heddle, WF, Podczeck-Schweighofer, A, Ebner, C, Scherr, D, Lang, IM, Huber, K, Guedes, A, Convens, C, Cools, F, Vercammen, J, Bartunek, J, Rossenbacker, T, Pereira, AH, Kormann, AM, Freitas, AF, Fonseca, AGT, de Quadros, A, Janella, BL, Kalil, CAA, Rodrigues, CS, Precoma, DB, Ramacciotti, E, Resende, ES, Figueiredo, EL, Manenti, ER, Costa, FAD, Feitosa, G, Reis, HJL, Ribeiro, HB, de Moraes, JBMX, Dantas, JMM, Nicolau, JC, Saraiva, JFK, Reolão, J, Piegas, LS, Oliveira, LFA, Ritt, LEF, Braile, MCVB, Dracoulakis, MA, de Santos, MON, Leães, PE, Filho, PP, Rech, RL, Ueda, R, Silvestrini, TL, Michalaros, YL, Manolova, A, Mihov, AK, Yatseva, B, Velikov, C, Raev, DH, Markov, D, Vassilev, D, Georgiev, E, Benov, HO, Daskalov, I, Petrov, IP, Milanova, M, Shehova-Yankova, NS, Lazov, PV, Beleva, S, Marchev, ST, Gelev, VL, Tyrrell, B, Wong, B, Dion, D, LaFlamme, D, Rupka, DW, Shukla, D, Sabbah, E, Nadra, IJ, Bata, I, Cherry, JM, Toleva, O, Dehghani, P, Vijayaraghavan, R, Welsh, R, Bagur, R, Labonte, RE, Vizel, S, Fort, S, Huynh, T, Quan, VH, Pesant, Y, Isaza, D, Accini Mendoza, JL, Gomez, JE, Jaramillo Gomez, NI, Knezevic, A, Ruzic, A, Horvat, D, Milicic, D, Selthofer-Relatic, K, Pesek, K, Pravecek, MK, Kovacic, M, Manola, S, Persic, V, Alan, D, Belohlavek, J, Larsen, CT, Brønnum-Schou, J, Veien, KT, Christensen, LS, Maeng, M, Steffensen, R, Angoulvant, D, Beygui, F, Range, G, Cayla, G, Aupetit, JF, Elbaz, M, Delarche, N, Meneveau, N, Ghanem, A, Hagendorff, A, Wilke, A, Hummel, A, Axthelm, C, Kadel, C, Langer, C, Stellbrink, C, Jacobshagen, C, Gross, CM, Blessing, EEB, Minden, HH, Bogossian, H, Wienbergen, H, Ebelt, H, Dreger, H, Ince, H, Akin, I, Eitel, I, Kreis, I, Appel, KF, Maier, L, Bergmann, M, Moser, M, Toursarkissian, N, Menck, N, Ritter, O, Bernhardt, P, Nordbeck, P, Stöhring, R, Schwinger, R, Braun-Dullaeus, RC, Maier, SKG, Schellong, S, Steiner, S, Rudolph, T, Dengler, TJ, Geisler, T, Rauch-Kröhnert, U, Jung, W, Jungmair, W, Komócsi, A, Papp, A, Vértes, A, Mohácsi, A, Herczeg, B, Merkely, B, Dézsi, CA, Kis, E, Lakatos, F, Kerecsen, G, Piros, GA, Takács, J, Tomcsányi, J, Keltai, K, Kovács, Z, Mathur, A, Baxi, HA, Narendra, J, Gupta, J, Kumbla, M, Jamwal, NK, Arora, P, Katz, A, Shotan, A, Schiff, E, Freedberg, NA, Amir, O, Hussein, O, Kracoff, OH, Alcalai, R, Adawi, SY, Viskin, S, Hayek, T, Hasin, Y, Rozenman, Y, Nam, CW, Lee, CW, Choi, DJ, Jeon, DS, Park, HW, Son, JW, Jeong, JO, Cha, KS, Oh, S, Rha, S-W, Park, YH, On, YK, Bazzoni Ruiz, AE, Valdespino, AR, Castro Montes, BE, Ramos Lopez, GA, Llamas Esperón, GA, Solache, G, Macías García, JS, Leiva-Pons, JL, De Los Rios Ibarra, MO, Willems, FF, Beyerbacht, HP, van de Wal, R, Hysing, J, Lappegard, KT, Vinge, LE, Halvorsen, S, Pönitz, V, Chavez Ayala, CA, Medina Palomino, FA, Garcia Matheus, JC, Włodarczak, A, Lubinski, A, Czarnecka, D, Wojciechowski, D, Skonieczny, G, Kasprzak, JD, Wranicz, JK, Szachniewicz, J, Kincel, KK, Zmudka, K, Lesiak, M, Piekarski, M, Wujkowski, M, Lica-Gorzynska, M, Miekus, P, Feusette, P, Bartkowiak, R, Korzeniak, R, Sinkiewicz, W, Musial, W, Krolikowski, Z, Gaspar, A, Pinto, F, Almeida, F, Martinez, J, Brandão, L, Santos, LM, Mateus, P, Monteiro, P, Pernencar, S, Mornoş, C, Olinic, DM, Zdrenghea, DT, Ortan, FO, Cinteza, M, Popescu, M, Voicu, O, Todea, SBF, Babes, V, Vishnevskiy, AY, Kuimov, AD, Duplyakov, DV, Kosmacheva, E, Pokushalov, E, Gordeev, IG, Zrazhevskiy, KN, Sorokin, LA, Ermoshkina, LG, Zykov, MV, Ruda, MY, Bulashova, O, Smolenskaya, OG, Orlikova, OV, Grishaev, SL, Shalaev, SV, Boldueva, SA, Kuznetsov, V, Makukhin, V, Kostenko, V, Shvarts, Y, Kobalava, ZD, Selakovic, A, Tosic, BP, Sakac, DB, Pavlovic, M, Dekleva, M, Tasic, NM, Hinic, S, Jozic, T, Potpara, T, Dzupina, A, Pella, D, Majercak, I, Striezova, I, Fedacko, J, Gonsorcik, J, Fecik, J, Selecky, J, Antalik, L, Hranai, M, Gocar, M, Kokles, M, Oriesek, R, Regueiro, A, Ibánez, B, Djurovic, DP, Gutierrez Ibañes, E, Ridocci-Soriano, F, Diaz Fernandez, J, Artaecheverria Zuazo, JJ, Escudier Villa, JM, Nuñez Villota, J, Sanmartin Fernandez, M, Chinchurreta Capote, PA, Muñoz Aguilera, R, Vera Ripoll, T, Mainar Tello, V, Björklund, F, Jensen, J, Andersson, J, Lauermann, J, Hamid, M, Angerås, O, Fischer, TA, Yagensky, AV, Goloborodko, BI, Kyrychenko, II, Vakaliuk, IP, Kovalskyy, I, Rishko, MV, Sydor, N, Karpenko, OI, Parkhomenko, OM, Koval, OA, Godlevska, O, Zhurba, S, Maslovskyi, VY, Netiazhenko, VZ, Tashchuk, VK, Shcherbak, VP, Tseluyko, VI, Cooke, A, Wrigley, B, Francis, CM, Barr, C, Gorog, DA, Lip, GYH, Irving, J, Mills, J, Levy, T, Cheema, AA, Salacata, AS, Tenaglia, AN, Meholick, AW, Vedere, AR, Patrello, AJ, Spaedy, A, Martin, AC, Holland, BH, Duffy, BK, Schuler, B, Treasure, CB, Paraboschi, C, Pickett, CA, Rowan, CJ, Longnecker, CR, Hess, CN, Hinchman, DA, Schneider, DJ, Murdock, DK, Baldwin, DE, Flores, EA, Sirulnick, EJ, Ahmad, F, Aggarwala, G, Dhar, G, Kichura, GM, Turitto, G, Sampognaro, GC, Sharma, GK, Chandna, H, Truong, HTD, Poock, J, Walia, JS, Zelenka, JT, Amin, JK, Foucauld, J, Chambers, J, Abbott, JD, Strobel, JS, Dy, JR, Nour, KA, Sullenberger, LE, Younis, LT, Gonzales, L, Chane, M, Foster, MT, King, MY, Grabarczyk, MA, Izzo, MR, Leesar, MA, Bernabei, MA, Cavender, MD, Janik, MJ, Buchbinder, M, Arcarese, M, Yeh, M, Sheth, MJ, Sinno, MC, Shoukfeh, MF, Alhaddad, M, Ranadive, NV, Jaffrani, NA, Little, NK, Shammas, N, Assi, NA, Almousalli, O, Chan, P, Horwitz, PA, Rozeman, PA, Singh, P, Aggarwal, R, Gopinathannair, R, Manshadi, R, Korabathina, R, Gilmore, RM, Feldman, RB, Schnitzler, RN, Harrison, RW, Gandhi, SN, Graham, S, Krueger, SK, Jones, SE, Rowe, SK, Bazaz, SB, Haddad, TM, Povsic, TJ, Badami, UA, Abernethy, WB & Mirza, ZA 2019, 'Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation', New England Journal of Medicine, vol. 380, no. 16, pp. 1509-1524. https://doi.org/10.1056/NEJMoa1817083
Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R et al. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. New England Journal of Medicine. 2019 Apr 18;380(16):1509-1524. https://doi.org/10.1056/NEJMoa1817083
Lopes, Renato D. ; Heizer, Gretchen ; Aronson, Ronald ; Vora, Amit N. ; Massaro, Tyler ; Mehran, Roxana ; Goodman, Shaun G. ; Windecker, Stephan ; Darius, Harald ; Li, Jia ; Averkov, Oleg ; Bahit, M. Cecilia ; Berwanger, Otavio ; Budaj, Andrzej ; Hijazi, Ziad ; Parkhomenko, Alexander ; Sinnaeve, Peter ; Storey, Robert F. ; Thiele, Holger ; Vinereanu, Dragos ; Granger, Christopher B. ; Alexander, John H. ; Hrabar, A. D. ; Caccavo, A. ; Licheri, A. ; Alvarisqueta, A. F. ; Abud, A. M. ; Estrada, C. ; Sueldo, C. P. ; Montenegro, E. ; Duronto, E. A. ; Blanco, F. L. ; Berra, F. C. ; Ferré Pácora, F. A. ; Lopez, G. M. ; Calvo, G. ; Azize, G. M. ; Luquez, H. A. ; Ramos, H. ; Colombo, H. R. ; Guetta, J. N. ; Resk, J. H. ; Medrano, J. C. ; Costabel, J. P. ; Carbajales, J. ; Schiavi, L. B. ; Saggia, L. I. ; Oliva, M. A. ; Casas, M. ; Snitman, M. ; Litvak Bruno, M. R. ; Cluigt, N. ; Vita, N. A. ; Guzman, P. N. ; Zangroniz, P. D. ; Villarreal, R. A. ; Bonato, R. R. ; Nani, S. ; Sassone, S. A. ; Macin, S. M. ; Arias, V. E. ; Alexopoulos, C. ; Brieger, D. ; Colquhoun, D. ; Heddle, W. F. ; Podczeck-Schweighofer, A. ; Ebner, C. ; Scherr, D. ; Lang, I. M. ; Huber, K. ; Guedes, A. ; Convens, C. ; Cools, F. ; Vercammen, J. ; Bartunek, J. ; Rossenbacker, T. ; Pereira, A. H. ; Kormann, A. M. ; Freitas, A. F. ; Fonseca, A. G.T. ; de Quadros, A. ; Janella, B. L. ; Kalil, C. A.A. ; Rodrigues, C. S. ; Precoma, D. B. ; Ramacciotti, E. ; Resende, E. S. ; Figueiredo, E. L. ; Manenti, E. R. ; Costa, F. A.D. ; Feitosa, G. ; Reis, H. J.L. ; Ribeiro, H. B. ; de Moraes, J. B.M.X. ; Dantas, J. M.M. ; Nicolau, J. C. ; Saraiva, J. F.K. ; Reolão, J. ; Piegas, L. S. ; Oliveira, L. F.A. ; Ritt, L. E.F. ; Braile, M. C.V.B. ; Dracoulakis, M. A. ; de Santos, M. O.N. ; Leães, P. E. ; Filho, P. P. ; Rech, R. L. ; Ueda, R. ; Silvestrini, T. L. ; Michalaros, Y. L. ; Manolova, A. ; Mihov, A. K. ; Yatseva, B. ; Velikov, C. ; Raev, D. H. ; Markov, D. ; Vassilev, D. ; Georgiev, E. ; Benov, H. O. ; Daskalov, I. ; Petrov, I. P. ; Milanova, M. ; Shehova-Yankova, N. S. ; Lazov, P. V. ; Beleva, S. ; Marchev, S. T. ; Gelev, V. L. ; Tyrrell, B. ; Wong, B. ; Dion, D. ; LaFlamme, D. ; Rupka, D. W. ; Shukla, D. ; Sabbah, E. ; Nadra, I. J. ; Bata, I. ; Cherry, J. M. ; Toleva, O. ; Dehghani, P. ; Vijayaraghavan, R. ; Welsh, R. ; Bagur, R. ; Labonte, R. E. ; Vizel, S. ; Fort, S. ; Huynh, T. ; Quan, V. H. ; Pesant, Y. ; Isaza, D. ; Accini Mendoza, J. L. ; Gomez, J. E. ; Jaramillo Gomez, N. I. ; Knezevic, A. ; Ruzic, A. ; Horvat, D. ; Milicic, D. ; Selthofer-Relatic, K. ; Pesek, K. ; Pravecek, M. K. ; Kovacic, M. ; Manola, S. ; Persic, V. ; Alan, D. ; Belohlavek, J. ; Larsen, C. T. ; Brønnum-Schou, J. ; Veien, K. T. ; Christensen, L. S. ; Maeng, M. ; Steffensen, R. ; Angoulvant, D. ; Beygui, F. ; Range, G. ; Cayla, G. ; Aupetit, J. F. ; Elbaz, M. ; Delarche, N. ; Meneveau, N. ; Ghanem, A. ; Hagendorff, A. ; Wilke, A. ; Hummel, A. ; Axthelm, C. ; Kadel, C. ; Langer, C. ; Stellbrink, C. ; Jacobshagen, C. ; Gross, C. M. ; Blessing, E. E.B. ; Minden, H. H. ; Bogossian, H. ; Wienbergen, H. ; Ebelt, H. ; Dreger, H. ; Ince, H. ; Akin, I. ; Eitel, I. ; Kreis, I. ; Appel, K. F. ; Maier, L. ; Bergmann, M. ; Moser, M. ; Toursarkissian, N. ; Menck, N. ; Ritter, O. ; Bernhardt, P. ; Nordbeck, P. ; Stöhring, R. ; Schwinger, R. ; Braun-Dullaeus, R. C. ; Maier, S. K.G. ; Schellong, S. ; Steiner, S. ; Rudolph, T. ; Dengler, T. J. ; Geisler, T. ; Rauch-Kröhnert, U. ; Jung, W. ; Jungmair, W. ; Komócsi, A. ; Papp, A. ; Vértes, A. ; Mohácsi, A. ; Herczeg, B. ; Merkely, B. ; Dézsi, C. A. ; Kis, E. ; Lakatos, F. ; Kerecsen, G. ; Piros, G. A. ; Takács, J. ; Tomcsányi, J. ; Keltai, K. ; Kovács, Z. ; Mathur, A. ; Baxi, H. A. ; Narendra, J. ; Gupta, J. ; Kumbla, M. ; Jamwal, N. K. ; Arora, P. ; Katz, A. ; Shotan, A. ; Schiff, E. ; Freedberg, N. A. ; Amir, O. ; Hussein, O. ; Kracoff, O. H. ; Alcalai, R. ; Adawi, S. Y. ; Viskin, S. ; Hayek, T. ; Hasin, Y. ; Rozenman, Y. ; Nam, C. W. ; Lee, C. W. ; Choi, D. J. ; Jeon, D. S. ; Park, H. W. ; Son, J. W. ; Jeong, J. O. ; Cha, K. S. ; Oh, S. ; Rha, Seung-Woon ; Park, Y. H. ; On, Y. K. ; Bazzoni Ruiz, A. E. ; Valdespino, A. R. ; Castro Montes, B. E. ; Ramos Lopez, G. A. ; Llamas Esperón, G. A. ; Solache, G. ; Macías García, J. S. ; Leiva-Pons, J. L. ; De Los Rios Ibarra, M. O. ; Willems, F. F. ; Beyerbacht, H. P. ; van de Wal, R. ; Hysing, J. ; Lappegard, K. T. ; Vinge, L. E. ; Halvorsen, S. ; Pönitz, V. ; Chavez Ayala, C. A. ; Medina Palomino, F. A. ; Garcia Matheus, J. C. ; Włodarczak, A. ; Lubinski, A. ; Czarnecka, D. ; Wojciechowski, D. ; Skonieczny, G. ; Kasprzak, J. D. ; Wranicz, J. K. ; Szachniewicz, J. ; Kincel, K. K. ; Zmudka, K. ; Lesiak, M. ; Piekarski, M. ; Wujkowski, M. ; Lica-Gorzynska, M. ; Miekus, P. ; Feusette, P. ; Bartkowiak, R. ; Korzeniak, R. ; Sinkiewicz, W. ; Musial, W. ; Krolikowski, Z. ; Gaspar, A. ; Pinto, F. ; Almeida, F. ; Martinez, J. ; Brandão, L. ; Santos, L. M. ; Mateus, P. ; Monteiro, P. ; Pernencar, S. ; Mornoş, C. ; Olinic, D. M. ; Zdrenghea, D. T. ; Ortan, F. O. ; Cinteza, M. ; Popescu, M. ; Voicu, O. ; Todea, S. B.F. ; Babes, V. ; Vishnevskiy, A. Y. ; Kuimov, A. D. ; Duplyakov, D. V. ; Kosmacheva, E. ; Pokushalov, E. ; Gordeev, I. G. ; Zrazhevskiy, K. N. ; Sorokin, L. A. ; Ermoshkina, L. G. ; Zykov, M. V. ; Ruda, M. Y. ; Bulashova, O. ; Smolenskaya, O. G. ; Orlikova, O. V. ; Grishaev, S. L. ; Shalaev, S. V. ; Boldueva, S. A. ; Kuznetsov, V. ; Makukhin, V. ; Kostenko, V. ; Shvarts, Y. ; Kobalava, Z. D. ; Selakovic, A. ; Tosic, B. P. ; Sakac, D. B. ; Pavlovic, M. ; Dekleva, M. ; Tasic, N. M. ; Hinic, S. ; Jozic, T. ; Potpara, T. ; Dzupina, A. ; Pella, D. ; Majercak, I. ; Striezova, I. ; Fedacko, J. ; Gonsorcik, J. ; Fecik, J. ; Selecky, J. ; Antalik, L. ; Hranai, M. ; Gocar, M. ; Kokles, M. ; Oriesek, R. ; Regueiro, A. ; Ibánez, B. ; Djurovic, D. P. ; Gutierrez Ibañes, E. ; Ridocci-Soriano, F. ; Diaz Fernandez, J. ; Artaecheverria Zuazo, J. J. ; Escudier Villa, J. M. ; Nuñez Villota, J. ; Sanmartin Fernandez, M. ; Chinchurreta Capote, P. A. ; Muñoz Aguilera, R. ; Vera Ripoll, T. ; Mainar Tello, V. ; Björklund, F. ; Jensen, J. ; Andersson, J. ; Lauermann, J. ; Hamid, M. ; Angerås, O. ; Fischer, T. A. ; Yagensky, A. V. ; Goloborodko, B. I. ; Kyrychenko, I. I. ; Vakaliuk, I. P. ; Kovalskyy, I. ; Rishko, M. V. ; Sydor, N. ; Karpenko, O. I. ; Parkhomenko, O. M. ; Koval, O. A. ; Godlevska, O. ; Zhurba, S. ; Maslovskyi, V. Y. ; Netiazhenko, V. Z. ; Tashchuk, V. K. ; Shcherbak, V. P. ; Tseluyko, V. I. ; Cooke, A. ; Wrigley, B. ; Francis, C. M. ; Barr, C. ; Gorog, D. A. ; Lip, G. Y.H. ; Irving, J. ; Mills, J. ; Levy, T. ; Cheema, A. A. ; Salacata, A. S. ; Tenaglia, A. N. ; Meholick, A. W. ; Vedere, A. R. ; Patrello, A. J. ; Spaedy, A. ; Martin, A. C. ; Holland, B. H. ; Duffy, B. K. ; Schuler, B. ; Treasure, C. B. ; Paraboschi, C. ; Pickett, C. A. ; Rowan, C. J. ; Longnecker, C. R. ; Hess, C. N. ; Hinchman, D. A. ; Schneider, D. J. ; Murdock, D. K. ; Baldwin, D. E. ; Flores, E. A. ; Sirulnick, E. J. ; Ahmad, F. ; Aggarwala, G. ; Dhar, G. ; Kichura, G. M. ; Turitto, G. ; Sampognaro, G. C. ; Sharma, G. K. ; Chandna, H. ; Truong, H. T.D. ; Poock, J. ; Walia, J. S. ; Zelenka, J. T. ; Amin, J. K. ; Foucauld, J. ; Chambers, J. ; Abbott, J. D. ; Strobel, J. S. ; Dy, J. R. ; Nour, K. A. ; Sullenberger, L. E. ; Younis, L. T. ; Gonzales, L. ; Chane, M. ; Foster, M. T. ; King, M. Y. ; Grabarczyk, M. A. ; Izzo, M. R. ; Leesar, M. A. ; Bernabei, M. A. ; Cavender, M. D. ; Janik, M. J. ; Buchbinder, M. ; Arcarese, M. ; Yeh, M. ; Sheth, M. J. ; Sinno, M. C. ; Shoukfeh, M. F. ; Alhaddad, M. ; Ranadive, N. V. ; Jaffrani, N. A. ; Little, N. K. ; Shammas, N. ; Assi, N. A. ; Almousalli, O. ; Chan, P. ; Horwitz, P. A. ; Rozeman, P. A. ; Singh, P. ; Aggarwal, R. ; Gopinathannair, R. ; Manshadi, R. ; Korabathina, R. ; Gilmore, R. M. ; Feldman, R. B. ; Schnitzler, R. N. ; Harrison, R. W. ; Gandhi, S. N. ; Graham, S. ; Krueger, S. K. ; Jones, S. E. ; Rowe, S. K. ; Bazaz, S. B. ; Haddad, T. M. ; Povsic, T. J. ; Badami, U. A. ; Abernethy, W. B. ; Mirza, Z. A. / Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. In: New England Journal of Medicine. 2019 ; Vol. 380, No. 16. pp. 1509-1524.
@article{035f439a574d4c81a2b012cfa85a4f9a,
title = "Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation",
abstract = "BACKGROUND Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. METHODS In an international trial with a two-by-two factorial design, we randomly assigned patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y12 inhibitor to receive apixaban or a Vitamin K antagonist and to receive aspirin or matching placebo for 6 months. The primary outcome was major or clinically relevant nonmajor bleeding. Secondary outcomes included death or hospitalization and a composite of ischemic events. RESULTS Enrollment included 4614 patients from 33 countries. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. Major or clinically relevant nonmajor bleeding was noted in 10.5{\%} of the patients receiving apixaban, as compared with 14.7{\%} of those receiving a Vitamin K antagonist (hazard ratio, 0.69; 95{\%} confidence interval [CI], 0.58 to 0.81; P<0.001 for both noninferiority and superiority), and in 16.1{\%} of the patients receiving aspirin, as compared with 9.0{\%} of those receiving placebo (hazard ratio, 1.89; 95{\%} CI, 1.59 to 2.24; P<0.001). Patients in the apixaban group had a lower incidence of death or hospitalization than those in the Vitamin K antagonist group (23.5{\%} vs. 27.4{\%}; hazard ratio, 0.83; 95{\%} CI, 0.74 to 0.93; P = 0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group. CONCLUSIONS In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a Vitamin K antagonist, aspirin, or both.",
author = "Lopes, {Renato D.} and Gretchen Heizer and Ronald Aronson and Vora, {Amit N.} and Tyler Massaro and Roxana Mehran and Goodman, {Shaun G.} and Stephan Windecker and Harald Darius and Jia Li and Oleg Averkov and Bahit, {M. Cecilia} and Otavio Berwanger and Andrzej Budaj and Ziad Hijazi and Alexander Parkhomenko and Peter Sinnaeve and Storey, {Robert F.} and Holger Thiele and Dragos Vinereanu and Granger, {Christopher B.} and Alexander, {John H.} and Hrabar, {A. D.} and A. Caccavo and A. Licheri and Alvarisqueta, {A. F.} and Abud, {A. M.} and C. Estrada and Sueldo, {C. P.} and E. Montenegro and Duronto, {E. A.} and Blanco, {F. L.} and Berra, {F. C.} and {Ferr{\'e} P{\'a}cora}, {F. A.} and Lopez, {G. M.} and G. Calvo and Azize, {G. M.} and Luquez, {H. A.} and H. Ramos and Colombo, {H. R.} and Guetta, {J. N.} and Resk, {J. H.} and Medrano, {J. C.} and Costabel, {J. P.} and J. Carbajales and Schiavi, {L. B.} and Saggia, {L. I.} and Oliva, {M. A.} and M. Casas and M. Snitman and {Litvak Bruno}, {M. R.} and N. Cluigt and Vita, {N. A.} and Guzman, {P. N.} and Zangroniz, {P. D.} and Villarreal, {R. A.} and Bonato, {R. R.} and S. Nani and Sassone, {S. A.} and Macin, {S. M.} and Arias, {V. E.} and C. Alexopoulos and D. Brieger and D. Colquhoun and Heddle, {W. F.} and A. Podczeck-Schweighofer and C. Ebner and D. Scherr and Lang, {I. M.} and K. Huber and A. Guedes and C. Convens and F. Cools and J. Vercammen and J. Bartunek and T. Rossenbacker and Pereira, {A. H.} and Kormann, {A. M.} and Freitas, {A. F.} and Fonseca, {A. G.T.} and {de Quadros}, A. and Janella, {B. L.} and Kalil, {C. A.A.} and Rodrigues, {C. S.} and Precoma, {D. B.} and E. Ramacciotti and Resende, {E. S.} and Figueiredo, {E. L.} and Manenti, {E. R.} and Costa, {F. A.D.} and G. Feitosa and Reis, {H. J.L.} and Ribeiro, {H. B.} and {de Moraes}, {J. B.M.X.} and Dantas, {J. M.M.} and Nicolau, {J. C.} and Saraiva, {J. F.K.} and J. Reol{\~a}o and Piegas, {L. S.} and Oliveira, {L. F.A.} and Ritt, {L. E.F.} and Braile, {M. C.V.B.} and Dracoulakis, {M. A.} and {de Santos}, {M. O.N.} and Le{\~a}es, {P. E.} and Filho, {P. P.} and Rech, {R. L.} and R. Ueda and Silvestrini, {T. L.} and Michalaros, {Y. L.} and A. Manolova and Mihov, {A. K.} and B. Yatseva and C. Velikov and Raev, {D. H.} and D. Markov and D. Vassilev and E. Georgiev and Benov, {H. O.} and I. Daskalov and Petrov, {I. P.} and M. Milanova and Shehova-Yankova, {N. S.} and Lazov, {P. V.} and S. Beleva and Marchev, {S. T.} and Gelev, {V. L.} and B. Tyrrell and B. Wong and D. Dion and D. LaFlamme and Rupka, {D. W.} and D. Shukla and E. Sabbah and Nadra, {I. J.} and I. Bata and Cherry, {J. M.} and O. Toleva and P. Dehghani and R. Vijayaraghavan and R. Welsh and R. Bagur and Labonte, {R. E.} and S. Vizel and S. Fort and T. Huynh and Quan, {V. H.} and Y. Pesant and D. Isaza and {Accini Mendoza}, {J. L.} and Gomez, {J. E.} and {Jaramillo Gomez}, {N. I.} and A. Knezevic and A. Ruzic and D. Horvat and D. Milicic and K. Selthofer-Relatic and K. Pesek and Pravecek, {M. K.} and M. Kovacic and S. Manola and V. Persic and D. Alan and J. Belohlavek and Larsen, {C. T.} and J. Br{\o}nnum-Schou and Veien, {K. T.} and Christensen, {L. S.} and M. Maeng and R. Steffensen and D. Angoulvant and F. Beygui and G. Range and G. Cayla and Aupetit, {J. F.} and M. Elbaz and N. Delarche and N. Meneveau and A. Ghanem and A. Hagendorff and A. Wilke and A. Hummel and C. Axthelm and C. Kadel and C. Langer and C. Stellbrink and C. Jacobshagen and Gross, {C. M.} and Blessing, {E. E.B.} and Minden, {H. H.} and H. Bogossian and H. Wienbergen and H. Ebelt and H. Dreger and H. Ince and I. Akin and I. Eitel and I. Kreis and Appel, {K. F.} and L. Maier and M. Bergmann and M. Moser and N. Toursarkissian and N. Menck and O. Ritter and P. Bernhardt and P. Nordbeck and R. St{\"o}hring and R. Schwinger and Braun-Dullaeus, {R. C.} and Maier, {S. K.G.} and S. Schellong and S. Steiner and T. Rudolph and Dengler, {T. J.} and T. Geisler and U. Rauch-Kr{\"o}hnert and W. Jung and W. Jungmair and A. Kom{\'o}csi and A. Papp and A. V{\'e}rtes and A. Moh{\'a}csi and B. Herczeg and B. Merkely and D{\'e}zsi, {C. A.} and E. Kis and F. Lakatos and G. Kerecsen and Piros, {G. A.} and J. Tak{\'a}cs and J. Tomcs{\'a}nyi and K. Keltai and Z. Kov{\'a}cs and A. Mathur and Baxi, {H. A.} and J. Narendra and J. Gupta and M. Kumbla and Jamwal, {N. K.} and P. Arora and A. Katz and A. Shotan and E. Schiff and Freedberg, {N. A.} and O. Amir and O. Hussein and Kracoff, {O. H.} and R. Alcalai and Adawi, {S. Y.} and S. Viskin and T. Hayek and Y. Hasin and Y. Rozenman and Nam, {C. W.} and Lee, {C. W.} and Choi, {D. J.} and Jeon, {D. S.} and Park, {H. W.} and Son, {J. W.} and Jeong, {J. O.} and Cha, {K. S.} and S. Oh and Seung-Woon Rha and Park, {Y. H.} and On, {Y. K.} and {Bazzoni Ruiz}, {A. E.} and Valdespino, {A. R.} and {Castro Montes}, {B. E.} and {Ramos Lopez}, {G. A.} and {Llamas Esper{\'o}n}, {G. A.} and G. Solache and {Mac{\'i}as Garc{\'i}a}, {J. S.} and Leiva-Pons, {J. L.} and {De Los Rios Ibarra}, {M. O.} and Willems, {F. F.} and Beyerbacht, {H. P.} and {van de Wal}, R. and J. Hysing and Lappegard, {K. T.} and Vinge, {L. E.} and S. Halvorsen and V. P{\"o}nitz and {Chavez Ayala}, {C. A.} and {Medina Palomino}, {F. A.} and {Garcia Matheus}, {J. C.} and A. Włodarczak and A. Lubinski and D. Czarnecka and D. Wojciechowski and G. Skonieczny and Kasprzak, {J. D.} and Wranicz, {J. K.} and J. Szachniewicz and Kincel, {K. K.} and K. Zmudka and M. Lesiak and M. Piekarski and M. Wujkowski and M. Lica-Gorzynska and P. Miekus and P. Feusette and R. Bartkowiak and R. Korzeniak and W. Sinkiewicz and W. Musial and Z. Krolikowski and A. Gaspar and F. Pinto and F. Almeida and J. Martinez and L. Brand{\~a}o and Santos, {L. M.} and P. Mateus and P. Monteiro and S. Pernencar and C. Mornoş and Olinic, {D. M.} and Zdrenghea, {D. T.} and Ortan, {F. O.} and M. Cinteza and M. Popescu and O. Voicu and Todea, {S. B.F.} and V. Babes and Vishnevskiy, {A. Y.} and Kuimov, {A. D.} and Duplyakov, {D. V.} and E. Kosmacheva and E. Pokushalov and Gordeev, {I. G.} and Zrazhevskiy, {K. N.} and Sorokin, {L. A.} and Ermoshkina, {L. G.} and Zykov, {M. V.} and Ruda, {M. Y.} and O. Bulashova and Smolenskaya, {O. G.} and Orlikova, {O. V.} and Grishaev, {S. L.} and Shalaev, {S. V.} and Boldueva, {S. A.} and V. Kuznetsov and V. Makukhin and V. Kostenko and Y. Shvarts and Kobalava, {Z. D.} and A. Selakovic and Tosic, {B. P.} and Sakac, {D. B.} and M. Pavlovic and M. Dekleva and Tasic, {N. M.} and S. Hinic and T. Jozic and T. Potpara and A. Dzupina and D. Pella and I. Majercak and I. Striezova and J. Fedacko and J. Gonsorcik and J. Fecik and J. Selecky and L. Antalik and M. Hranai and M. Gocar and M. Kokles and R. Oriesek and A. Regueiro and B. Ib{\'a}nez and Djurovic, {D. P.} and {Gutierrez Iba{\~n}es}, E. and F. Ridocci-Soriano and {Diaz Fernandez}, J. and {Artaecheverria Zuazo}, {J. 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Alhaddad and Ranadive, {N. V.} and Jaffrani, {N. A.} and Little, {N. K.} and N. Shammas and Assi, {N. A.} and O. Almousalli and P. Chan and Horwitz, {P. A.} and Rozeman, {P. A.} and P. Singh and R. Aggarwal and R. Gopinathannair and R. Manshadi and R. Korabathina and Gilmore, {R. M.} and Feldman, {R. B.} and Schnitzler, {R. N.} and Harrison, {R. W.} and Gandhi, {S. N.} and S. Graham and Krueger, {S. K.} and Jones, {S. E.} and Rowe, {S. K.} and Bazaz, {S. B.} and Haddad, {T. M.} and Povsic, {T. J.} and Badami, {U. A.} and Abernethy, {W. B.} and Mirza, {Z. A.}",
year = "2019",
month = "4",
day = "18",
doi = "10.1056/NEJMoa1817083",
language = "English",
volume = "380",
pages = "1509--1524",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "16",

}

TY - JOUR

T1 - Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation

AU - Lopes, Renato D.

AU - Heizer, Gretchen

AU - Aronson, Ronald

AU - Vora, Amit N.

AU - Massaro, Tyler

AU - Mehran, Roxana

AU - Goodman, Shaun G.

AU - Windecker, Stephan

AU - Darius, Harald

AU - Li, Jia

AU - Averkov, Oleg

AU - Bahit, M. Cecilia

AU - Berwanger, Otavio

AU - Budaj, Andrzej

AU - Hijazi, Ziad

AU - Parkhomenko, Alexander

AU - Sinnaeve, Peter

AU - Storey, Robert F.

AU - Thiele, Holger

AU - Vinereanu, Dragos

AU - Granger, Christopher B.

AU - Alexander, John H.

AU - Hrabar, A. D.

AU - Caccavo, A.

AU - Licheri, A.

AU - Alvarisqueta, A. F.

AU - Abud, A. M.

AU - Estrada, C.

AU - Sueldo, C. P.

AU - Montenegro, E.

AU - Duronto, E. A.

AU - Blanco, F. L.

AU - Berra, F. C.

AU - Ferré Pácora, F. A.

AU - Lopez, G. M.

AU - Calvo, G.

AU - Azize, G. M.

AU - Luquez, H. A.

AU - Ramos, H.

AU - Colombo, H. R.

AU - Guetta, J. N.

AU - Resk, J. H.

AU - Medrano, J. C.

AU - Costabel, J. P.

AU - Carbajales, J.

AU - Schiavi, L. B.

AU - Saggia, L. I.

AU - Oliva, M. A.

AU - Casas, M.

AU - Snitman, M.

AU - Litvak Bruno, M. R.

AU - Cluigt, N.

AU - Vita, N. A.

AU - Guzman, P. N.

AU - Zangroniz, P. D.

AU - Villarreal, R. A.

AU - Bonato, R. R.

AU - Nani, S.

AU - Sassone, S. A.

AU - Macin, S. M.

AU - Arias, V. E.

AU - Alexopoulos, C.

AU - Brieger, D.

AU - Colquhoun, D.

AU - Heddle, W. F.

AU - Podczeck-Schweighofer, A.

AU - Ebner, C.

AU - Scherr, D.

AU - Lang, I. M.

AU - Huber, K.

AU - Guedes, A.

AU - Convens, C.

AU - Cools, F.

AU - Vercammen, J.

AU - Bartunek, J.

AU - Rossenbacker, T.

AU - Pereira, A. H.

AU - Kormann, A. M.

AU - Freitas, A. F.

AU - Fonseca, A. G.T.

AU - de Quadros, A.

AU - Janella, B. L.

AU - Kalil, C. A.A.

AU - Rodrigues, C. S.

AU - Precoma, D. B.

AU - Ramacciotti, E.

AU - Resende, E. S.

AU - Figueiredo, E. L.

AU - Manenti, E. R.

AU - Costa, F. A.D.

AU - Feitosa, G.

AU - Reis, H. J.L.

AU - Ribeiro, H. B.

AU - de Moraes, J. B.M.X.

AU - Dantas, J. M.M.

AU - Nicolau, J. C.

AU - Saraiva, J. F.K.

AU - Reolão, J.

AU - Piegas, L. S.

AU - Oliveira, L. F.A.

AU - Ritt, L. E.F.

AU - Braile, M. C.V.B.

AU - Dracoulakis, M. A.

AU - de Santos, M. O.N.

AU - Leães, P. E.

AU - Filho, P. P.

AU - Rech, R. L.

AU - Ueda, R.

AU - Silvestrini, T. L.

AU - Michalaros, Y. L.

AU - Manolova, A.

AU - Mihov, A. K.

AU - Yatseva, B.

AU - Velikov, C.

AU - Raev, D. H.

AU - Markov, D.

AU - Vassilev, D.

AU - Georgiev, E.

AU - Benov, H. O.

AU - Daskalov, I.

AU - Petrov, I. P.

AU - Milanova, M.

AU - Shehova-Yankova, N. S.

AU - Lazov, P. V.

AU - Beleva, S.

AU - Marchev, S. T.

AU - Gelev, V. L.

AU - Tyrrell, B.

AU - Wong, B.

AU - Dion, D.

AU - LaFlamme, D.

AU - Rupka, D. W.

AU - Shukla, D.

AU - Sabbah, E.

AU - Nadra, I. J.

AU - Bata, I.

AU - Cherry, J. M.

AU - Toleva, O.

AU - Dehghani, P.

AU - Vijayaraghavan, R.

AU - Welsh, R.

AU - Bagur, R.

AU - Labonte, R. E.

AU - Vizel, S.

AU - Fort, S.

AU - Huynh, T.

AU - Quan, V. H.

AU - Pesant, Y.

AU - Isaza, D.

AU - Accini Mendoza, J. L.

AU - Gomez, J. E.

AU - Jaramillo Gomez, N. I.

AU - Knezevic, A.

AU - Ruzic, A.

AU - Horvat, D.

AU - Milicic, D.

AU - Selthofer-Relatic, K.

AU - Pesek, K.

AU - Pravecek, M. K.

AU - Kovacic, M.

AU - Manola, S.

AU - Persic, V.

AU - Alan, D.

AU - Belohlavek, J.

AU - Larsen, C. T.

AU - Brønnum-Schou, J.

AU - Veien, K. T.

AU - Christensen, L. S.

AU - Maeng, M.

AU - Steffensen, R.

AU - Angoulvant, D.

AU - Beygui, F.

AU - Range, G.

AU - Cayla, G.

AU - Aupetit, J. F.

AU - Elbaz, M.

AU - Delarche, N.

AU - Meneveau, N.

AU - Ghanem, A.

AU - Hagendorff, A.

AU - Wilke, A.

AU - Hummel, A.

AU - Axthelm, C.

AU - Kadel, C.

AU - Langer, C.

AU - Stellbrink, C.

AU - Jacobshagen, C.

AU - Gross, C. M.

AU - Blessing, E. E.B.

AU - Minden, H. H.

AU - Bogossian, H.

AU - Wienbergen, H.

AU - Ebelt, H.

AU - Dreger, H.

AU - Ince, H.

AU - Akin, I.

AU - Eitel, I.

AU - Kreis, I.

AU - Appel, K. F.

AU - Maier, L.

AU - Bergmann, M.

AU - Moser, M.

AU - Toursarkissian, N.

AU - Menck, N.

AU - Ritter, O.

AU - Bernhardt, P.

AU - Nordbeck, P.

AU - Stöhring, R.

AU - Schwinger, R.

AU - Braun-Dullaeus, R. C.

AU - Maier, S. K.G.

AU - Schellong, S.

AU - Steiner, S.

AU - Rudolph, T.

AU - Dengler, T. J.

AU - Geisler, T.

AU - Rauch-Kröhnert, U.

AU - Jung, W.

AU - Jungmair, W.

AU - Komócsi, A.

AU - Papp, A.

AU - Vértes, A.

AU - Mohácsi, A.

AU - Herczeg, B.

AU - Merkely, B.

AU - Dézsi, C. A.

AU - Kis, E.

AU - Lakatos, F.

AU - Kerecsen, G.

AU - Piros, G. A.

AU - Takács, J.

AU - Tomcsányi, J.

AU - Keltai, K.

AU - Kovács, Z.

AU - Mathur, A.

AU - Baxi, H. A.

AU - Narendra, J.

AU - Gupta, J.

AU - Kumbla, M.

AU - Jamwal, N. K.

AU - Arora, P.

AU - Katz, A.

AU - Shotan, A.

AU - Schiff, E.

AU - Freedberg, N. A.

AU - Amir, O.

AU - Hussein, O.

AU - Kracoff, O. H.

AU - Alcalai, R.

AU - Adawi, S. Y.

AU - Viskin, S.

AU - Hayek, T.

AU - Hasin, Y.

AU - Rozenman, Y.

AU - Nam, C. W.

AU - Lee, C. W.

AU - Choi, D. J.

AU - Jeon, D. S.

AU - Park, H. W.

AU - Son, J. W.

AU - Jeong, J. O.

AU - Cha, K. S.

AU - Oh, S.

AU - Rha, Seung-Woon

AU - Park, Y. H.

AU - On, Y. K.

AU - Bazzoni Ruiz, A. E.

AU - Valdespino, A. R.

AU - Castro Montes, B. E.

AU - Ramos Lopez, G. A.

AU - Llamas Esperón, G. A.

AU - Solache, G.

AU - Macías García, J. S.

AU - Leiva-Pons, J. L.

AU - De Los Rios Ibarra, M. O.

AU - Willems, F. F.

AU - Beyerbacht, H. P.

AU - van de Wal, R.

AU - Hysing, J.

AU - Lappegard, K. T.

AU - Vinge, L. E.

AU - Halvorsen, S.

AU - Pönitz, V.

AU - Chavez Ayala, C. A.

AU - Medina Palomino, F. A.

AU - Garcia Matheus, J. C.

AU - Włodarczak, A.

AU - Lubinski, A.

AU - Czarnecka, D.

AU - Wojciechowski, D.

AU - Skonieczny, G.

AU - Kasprzak, J. D.

AU - Wranicz, J. K.

AU - Szachniewicz, J.

AU - Kincel, K. K.

AU - Zmudka, K.

AU - Lesiak, M.

AU - Piekarski, M.

AU - Wujkowski, M.

AU - Lica-Gorzynska, M.

AU - Miekus, P.

AU - Feusette, P.

AU - Bartkowiak, R.

AU - Korzeniak, R.

AU - Sinkiewicz, W.

AU - Musial, W.

AU - Krolikowski, Z.

AU - Gaspar, A.

AU - Pinto, F.

AU - Almeida, F.

AU - Martinez, J.

AU - Brandão, L.

AU - Santos, L. M.

AU - Mateus, P.

AU - Monteiro, P.

AU - Pernencar, S.

AU - Mornoş, C.

AU - Olinic, D. M.

AU - Zdrenghea, D. T.

AU - Ortan, F. O.

AU - Cinteza, M.

AU - Popescu, M.

AU - Voicu, O.

AU - Todea, S. B.F.

AU - Babes, V.

AU - Vishnevskiy, A. Y.

AU - Kuimov, A. D.

AU - Duplyakov, D. V.

AU - Kosmacheva, E.

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AU - Badami, U. A.

AU - Abernethy, W. B.

AU - Mirza, Z. A.

PY - 2019/4/18

Y1 - 2019/4/18

N2 - BACKGROUND Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. METHODS In an international trial with a two-by-two factorial design, we randomly assigned patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y12 inhibitor to receive apixaban or a Vitamin K antagonist and to receive aspirin or matching placebo for 6 months. The primary outcome was major or clinically relevant nonmajor bleeding. Secondary outcomes included death or hospitalization and a composite of ischemic events. RESULTS Enrollment included 4614 patients from 33 countries. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. Major or clinically relevant nonmajor bleeding was noted in 10.5% of the patients receiving apixaban, as compared with 14.7% of those receiving a Vitamin K antagonist (hazard ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.81; P<0.001 for both noninferiority and superiority), and in 16.1% of the patients receiving aspirin, as compared with 9.0% of those receiving placebo (hazard ratio, 1.89; 95% CI, 1.59 to 2.24; P<0.001). Patients in the apixaban group had a lower incidence of death or hospitalization than those in the Vitamin K antagonist group (23.5% vs. 27.4%; hazard ratio, 0.83; 95% CI, 0.74 to 0.93; P = 0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group. CONCLUSIONS In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a Vitamin K antagonist, aspirin, or both.

AB - BACKGROUND Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. METHODS In an international trial with a two-by-two factorial design, we randomly assigned patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y12 inhibitor to receive apixaban or a Vitamin K antagonist and to receive aspirin or matching placebo for 6 months. The primary outcome was major or clinically relevant nonmajor bleeding. Secondary outcomes included death or hospitalization and a composite of ischemic events. RESULTS Enrollment included 4614 patients from 33 countries. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. Major or clinically relevant nonmajor bleeding was noted in 10.5% of the patients receiving apixaban, as compared with 14.7% of those receiving a Vitamin K antagonist (hazard ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.81; P<0.001 for both noninferiority and superiority), and in 16.1% of the patients receiving aspirin, as compared with 9.0% of those receiving placebo (hazard ratio, 1.89; 95% CI, 1.59 to 2.24; P<0.001). Patients in the apixaban group had a lower incidence of death or hospitalization than those in the Vitamin K antagonist group (23.5% vs. 27.4%; hazard ratio, 0.83; 95% CI, 0.74 to 0.93; P = 0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group. CONCLUSIONS In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a Vitamin K antagonist, aspirin, or both.

UR - http://www.scopus.com/inward/record.url?scp=85063740593&partnerID=8YFLogxK

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U2 - 10.1056/NEJMoa1817083

DO - 10.1056/NEJMoa1817083

M3 - Article

VL - 380

SP - 1509

EP - 1524

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 16

ER -

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