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Impact of prior oral anticoagulant use and outcomes on patients from secondary analysis in the AUGUSTUS trial
- Source :
- Open Heart, Vol 9, Iss 1 (2022)
- Publication Year :
- 2022
- Publisher :
- BMJ Publishing Group, 2022.
-
Abstract
- ObjectiveManaging antithrombotic therapy in patients with atrial fibrillation (AF) and an acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) is challenging and can be affected by prior oral anticoagulant (OAC) treatment. We examined the relationship between prior OAC use and outcomes in the AUGUSTUS trial.MethodsThis prespecified secondary analysis is from AUGUSTUS, an open-label, 2-by-2 factorial, RCT to evaluate the safety of apixaban versus vitamin K antagonist (VKA) and aspirin versus placebo in patients with AF and ACS and/or PCI. The primary endpoint, major or clinically relevant non-major bleeding and clinical outcomes were compared in patients receiving (n=2262) or not receiving (n=2352) an OAC prior to enrolment.ResultsPatients with prior OAC use had more comorbidities, higher CHA2DS2-VASC and HAS-BLED scores, and were more likely enrolled following elective PCI. There was no difference in major or clinically relevant non-major bleeding with or without prior OAC (30 days: 5.1% vs 5.9% (adjusted HR (aHR) 0.82, 95% CI 0.63 to 1.06); 180 days: 13.5% vs 13.5% (aHR 0.98, 95% CI 0.83 to 1.16)). Patients with prior OAC use had a lower risk of death or ischaemic events (30 days: 1.7% vs 2.8% (aHR 0.61, 95% CI 0.41 to 0.92); 180 days: 5.4% vs 7.6% (aHR 0.70, 95% CI 0.55 to 0.88)). No interactions between randomised treatment (apixaban vs VKA, aspirin vs placebo) and prior OAC status were observed for outcomes, apart from apixaban (vs VKA) being associated with a lower risk of myocardial infarction with prior OAC use (180 days: 2.0% vs 3.7% (aHR 0.56, 95% CI 0.33 to 0.91().ConclusionsIn AUGUSTUS, prior OAC use was associated with fewer ischaemic events but not more bleeding. In patients with AF and ACS and/or undergoing PCI, clinicians can be assured that the trial results can be applied to patients regardless of their prior OAC status.Trial registration numberNCT02415400.
- Subjects :
- Male
Vitamin K
Aspirin
Medication Therapy Management
Pyridones
Hemorrhage
Middle Aged
Outcome and Process Assessment, Health Care
Percutaneous Coronary Intervention
Ischemia
RC666-701
Atrial Fibrillation
Preoperative Period
Humans
Pyrazoles
Diseases of the circulatory (Cardiovascular) system
Female
Acute Coronary Syndrome
Cardiology and Cardiovascular Medicine
Platelet Aggregation Inhibitors
Factor Xa Inhibitors
Subjects
Details
- Language :
- English
- ISSN :
- 20533624
- Volume :
- 9
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Open Heart
- Accession number :
- edsair.doi.dedup.....fce4ff9f86a024be4663dc85eb7b8d8a