From WOEST to AUGUSTUS: a review of safety and efficacy of triple versus dual antithrombotic regimens in patients with atrial fibrillation requiring percutaneous coronary intervention for acute coronary syndrome

Jones, David; Minhas, Sheharyar; Fierro, Joseph J.; Ardeshna, Devarshi; Rawal, Aranyak; Cave, Brandon; Shah, Samarth; Khouzam, Rami N.

doi:10.21037/atm.2019.08.21

Cited by 9 publications

(4 citation statements)

References 19 publications

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“…The recent AUGUSTUS study was designed for AF patients who had ACS or had undergone PCI and were taking a P 2 Y 12 inhibitor to receive apixaban or warfarin and aspirin or a matching placebo for 6 months ( 17 , 18 ). However, more than 90% of the individuals in this trial were treated with clopidogrel instead of more potent agents, such as ticagrelor.…”

Section: Introductionmentioning

confidence: 99%

Antithrombotic Therapy With Ticagrelor in Atrial Fibrillation Subjects After Percutaneous Coronary Intervention

Wang

Chen

et al. 2021

Front. Cardiovasc. Med.

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Background: Warfarin, along with aspirin and clopidogrel, has long been recommended for patients with atrial fibrillation (AF) who are undergoing percutaneous coronary intervention with a drug-eluting stent (PCI-DES). However, this triple therapy has been known to increase the risk of bleeding complications. Meanwhile, there is no evidence from prospective trials on the use of ticagrelor in a dual therapy. We here aimed to compare the antiplatelet drug ticagrelor as a dual antithrombotic agent to aspirin and clopidogrel in bleeding events.Methods: In this multicenter, active-controlled, open-label, randomized trial, patients with AF taking warfarin who had undergone PCI-DES were randomly assigned to the ticagrelor therapy group (Dual group) or the clopidogrel plus aspirin therapy group (Triple group). The primary and secondary endpoints were overall bleeding events and major bleeding events, respectively, according to the Thrombolysis in Myocardial Infarction (TIMI) criteria at 6 months. Cardiovascular events [re-PCI, surgical bypass, myocardial infarction (MI), heart failure, rehospitalization due to angina pectoris, stent thrombosis and death due to cardiovascular causes] at 6 months were also recorded.Results: A total of 296 patients from 12 medical centers in China were randomized after PCI-DES to either the Dual therapy group (n = 148) or the Triple group (n = 146) for 6 months. The overall incidence of bleeding events at 6 months was 36.49% in the Dual therapy group and 35.62% in the Triple group [hazard ratio, 0.930; 95% confidence interval (CI), 0.635 to 1.361; P = 0.7088]. The incidence of the secondary endpoint over 6 months was 4.73% in the Dual therapy group and 1.37% in the Triple group (hazard ratio, 0.273; 95% CI, 0.057 to 1.315; P = 0.1056). Cardiovascular event occurrence was also comparable in both groups at 6 months (18.24 vs. 16.44%; hazard ratio, 0.845; 95% CI, 0.488 to 1.465; P = 0.5484).Conclusions: The incidence of total bleeding events in AF patients treated with ticagrelor was comparable to that in patients treated with clopidogrel plus aspirin at 6 month; Meanwhile, the incidence of cardiovascular events were also comparable between the groups.Clinical Trial Registration: MANJUSRI, ClinicalTrials.gov# NCT02206815, 2014, August 1st

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Section: Introductionmentioning

confidence: 99%

Antithrombotic Therapy With Ticagrelor in Atrial Fibrillation Subjects After Percutaneous Coronary Intervention

Wang

Chen

et al. 2021

Front. Cardiovasc. Med.

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“…In patients with non-valvular AF undergoing PCI, dual therapy (OAC plus a single antiplatelet) has consistently been associated with a lower risk of major haemorrhage compared with triple therapy (OAC and dual antiplatelet therapy) but a signal to early ischaemic risk is recognised [ 76 ]. The AUGUSTUS trial (antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation) (discussed previously [ 56 ]) reported less bleeding with apixaban vs. vitamin K antagonist (VKA) and with placebo vs. aspirin at 6 months but the number of ischaemic events was numerically higher with placebo.…”

Section: Methodsmentioning

confidence: 99%

Advances in Clinical Cardiology 2020: A Summary of Key Clinical Trials

et al. 2021

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Introduction Despite the challenge of a global pandemic, 2020 has been an invaluable year in cardiology research with numerous important clinical trials published or presented virtually at major international meetings. This article aims to summarise these trials and place them in clinical context. Methods The authors reviewed clinical trials presented at major cardiology conferences during 2020 including the American College of Cardiology, European Association for Percutaneous Cardiovascular Interventions, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics and the American Heart Association. Trials with a broad relevance to the cardiology community and those with potential to change current practice were included. Results A total of 87 key cardiology clinical trials were identified for inclusion. New interventional and structural cardiology data included trials evaluating bifurcation percutaneous coronary intervention (PCI) techniques, intravascular ultrasound (IVUS)-guided PCI, instantaneous wave-free (iFR) physiological assessment, new generation stents (DynamX bioadaptor), transcatheter aortic valve implantation (TAVI) in low-risk patients, and percutaneous mitral or tricuspid valve interventions. Preventative cardiology data included new data with proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors (evolocumab and alirocumab), omega-3 supplements, evinacumab and colchicine in the setting of chronic coronary artery disease. Antiplatelet data included trials evaluating both the optimal length of course following PCI and combination of antiplatelet agents and regimes including combination antithrombotic therapies for patients with atrial fibrillation (AF). Heart failure data included the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors (sotagliflozin, empagliflozin and dapagliflozin) and mavacamten in hypertrophic cardiomyopathy. Electrophysiology trials included early rhythm control in AF and screening for AF. Conclusion This article presents a summary of key clinical cardiology trials during the past year and should be of relevance to both clinicians and cardiology researchers.

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“…29 There were no statistically significant differences in ischemic events or risk of stent thrombosis between the various cohorts. 30 Other meta-analyses of the same trials have found similar results. 31…”

Section: Meta-analysesmentioning

confidence: 60%

Role and Timing of Aspirin Therapy Following PCI in Patients With Atrial Fibrillation

Cannon

2021

The American Journal of Cardiology

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From WOEST to AUGUSTUS: a review of safety and efficacy of triple versus dual antithrombotic regimens in patients with atrial fibrillation requiring percutaneous coronary intervention for acute coronary syndrome

Cited by 9 publications

References 19 publications

Antithrombotic Therapy With Ticagrelor in Atrial Fibrillation Subjects After Percutaneous Coronary Intervention

Antithrombotic Therapy With Ticagrelor in Atrial Fibrillation Subjects After Percutaneous Coronary Intervention

Advances in Clinical Cardiology 2020: A Summary of Key Clinical Trials

Role and Timing of Aspirin Therapy Following PCI in Patients With Atrial Fibrillation

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