心房颤动患者口服抗凝药的双联与单联抗血小板疗法的相对益处取决于 ACS 和 PCI 后的时间:AUGUSTUS 试验的启示。

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation: Cardiovascular Interventions Pub Date : 2024-11-06 DOI:10.1161/CIRCINTERVENTIONS.123.013596
Alexander C Fanaroff, Daniel M Wojdyla, Christopher B Granger, Shaun G Goodman, Ronald S Aronson, Stephan Windecker, Roxana Mehran, John H Alexander, Renato D Lopes
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引用次数: 0

摘要

研究背景在AUGUSTUS试验(一项开放标签、2 x 2因子、随机对照、临床试验,以评估阿哌沙班与维生素K拮抗剂和阿司匹林与阿司匹林安慰剂在心房颤动和急性冠状动脉综合征或经皮冠状动脉介入治疗患者中的安全性)中、在心房颤动合并急性冠状动脉综合征或择期经皮冠状动脉介入治疗的患者中,与 P2Y12 抑制剂加口服抗凝药相比,双联抗血小板疗法加口服抗凝药会增加出血风险,但不会减少缺血性事件。然而,AUGUSTUS 纳入的患者多为急性冠状动脉综合征或经皮冠状动脉介入治疗后 14 天内的患者,因此在缺血事件发生后早期进行双联抗血小板治疗加口服抗凝治疗可能会有益处:在这项对 AUGUSTUS 的二次分析中,我们根据患者是否入组将其分为几组:在 4605 名加入 AUGUSTUS 并提供从指数事件到加入的时间数据的患者中,从指数事件到加入的中位时间为 6 天(范围为 0-14 天)。在 30 天或 6 个月的临床结果上,指数事件发生时间和阿司匹林与安慰剂之间没有明显的交互作用(尽管患者的指数事件发生时间 P=0.23)。阿哌沙班与维生素K拮抗剂相比,对临床结果的影响不明显:在急性冠状动脉综合征或接受经皮冠状动脉介入治疗的心房颤动患者中,阿哌沙班相对于维生素K拮抗剂或阿司匹林相对于安慰剂的相对获益没有差异:URL: https://www.clinicaltrials.gov; Unique identifier:NCT02415400。
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Relative Benefit of Dual Versus Single Antiplatelet Therapy Among Patients With Atrial Fibrillation on Oral Anticoagulation According to Time After ACS and PCI: Insights From the AUGUSTUS Trial.

Background: In the AUGUSTUS trial (An Open-Label, 2 x 2 Factorial, Randomized Controlled, Clinical Trial to Evaluate the Safety of Apixaban vs Vitamin K Antagonist and Aspirin vs Aspirin Placebo in Patients With Atrial Fibrillation and Acute Coronary Syndrome or Percutaneous Coronary Intervention), the combination of dual antiplatelet therapy plus oral anticoagulation increased the risk of bleeding without reducing ischemic events compared with a P2Y12 inhibitor plus oral anticoagulation among patients with atrial fibrillation and acute coronary syndrome or elective percutaneous coronary intervention. However, AUGUSTUS enrolled patients up to 14 days after acute coronary syndrome or percutaneous coronary intervention, and there may be a benefit to dual antiplatelet therapy plus oral anticoagulation early after an ischemic event.

Methods: In this secondary analysis of AUGUSTUS, we divided patients into groups based on whether they were enrolled <6 days (early) or ≥6 days (later) after their index acute coronary syndrome or percutaneous coronary intervention, and tested the interaction between time from the index event to enrollment and randomized treatment (apixaban versus vitamin K antagonist and aspirin versus placebo) on 30-day and 6-month clinical outcomes using Cox proportional hazards models.

Results: Among 4605 patients enrolled in AUGUSTUS with data available on time from the index event to enrollment, the median time from the index event to enrollment was 6 (range, 0-14) days. There were no significant interactions between time from the index event and aspirin versus placebo on clinical outcomes at 30 days or 6 months, though patients with time from the index event <6 days had a nominally significant reduction in death or ischemic events at 30 days with aspirin (hazard ratio, 0.55 [95% CI, 0.30-0.99]), whereas patients with time from the index event ≥6 days did not (hazard ratio, 0.88 [95% CI, 0.54-1.43]; interaction P=0.23). There were no significant interactions between time from the index event and apixaban versus vitamin K antagonist on clinical outcomes.

Conclusions: Among patients with atrial fibrillation with acute coronary syndrome or undergoing percutaneous coronary intervention, there was no difference in the relative benefit of apixaban versus vitamin K antagonist or aspirin versus placebo when patients were enrolled early versus later after their index event.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02415400.

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来源期刊
Circulation: Cardiovascular Interventions
Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
1.80%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
期刊最新文献
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