Rivaroxaban Monotherapy in Patients With Atrial Fibrillation After Coronary Stenting

Yasuda, Satoshi; Koretsune, Yukihiro; Hiro, Takafumi; Sumiyoshi, Tetsuya; Kimura, Kazumi; Hashimoto, Yoichiro; Hirano, Teruyuki; Daida, Hiroyuki; Okada, Yasushi; Yamazaki, Tsutomu; Hirayama, Atsushi; Nakamura, Masato; Miyauchi, Katsumi; Kaikita, Koichi; Matsui, Kunihiko; Nakamura, Asako; Tamiya, E.; Yamamoto, Takeshi; Suetake, S.; Noguchi, Teruo; Nakamura, S.; Kojima, Jisho; Suwa, Satoru; Yamaguchi, Hiroki; Kaikita, K; Yasu, Takanori; Nakajima, A.; Yamada, Tomomi; Arai, Hideki; Hata, Yutaka; Sakanashi, Toshihiko; Tateishi, Hiroki; Nakayama, Taira; Nozaki, Yoichi; Akao, Masaharu; Okumura, Yasuo; Tokue, Masahide; Kuroki, Nobutaka; Maruyama, Yasuyuki; Matoba, Tetsuya; Hagiwara, Nobuhisa; Suzuki, Hitoshi; Nishida, Yasunori; Ajioka, Masayoshi; Yumoto, Kazuhiko; Shimizu, Shogo; Shimomura, Hideki; Takeda, Takeshi; Oshiro, Koichi; Sugishita, Nobuyoshi; Shibata, Yohei; Otonari, Takatoshi; Kihara, Hajime; Ogawa, Hisao; Ohno, Ayaka; Hazama, Megumi; Shimizu, Mikiko; Tsukahara, Kengo; Haruta, Seiichi; Wakeyama, Takatoshi; Haruna, Tetsuya; Ito, Miwa; Fujii, Kenshi; Atsuchi, Nobuhiko; Sata, Michio; Kimura, Kazuo; Hasebe, N; Kobayasi, Youiti; Ohsato, Kazuo; Hironaga, Kiyoshi; Naganuma, Yujiro; Anzaki, Kazuhiro; Oiwa, Koji; Okazaki, Shinya; Nakagawa, Yuya; Tokuhiro, Keiichi; Tanaka, Kanta; Momose, Toshiya; Fukushima, Yoshifumi; Kametani, Ryosuke; Kawamitsu, Katsunori; Saito, Yuichi; Akashi, Shintaro; Kumagai, Koji; Eshima, Kenichi; Tobaru, Tetsuya; Seo, Toshihiko; Okuhara, Koichiro; Kozuma, Ken; Ikari, Yuji; Takahashi, Tohru; Michishita, Ichiro; Fujikura, Hisanori; Momomura, Shin‐ichi; Yamamoto, Yusuke; Otomo, Kenichiro; Matsubara, Takehiro; Tashiro, Hiroaki; Inoue, Takao; Ishihara, Masaharu; Shiojima, Ichiro; Tachibana, Eizo; Ako, Junya; Sumii, Kotaro; Yamamoto, Nobuto; Ohmura, Nobuhiro; Morita, Yukiko; Takahashi, Naomi; Watanabe, Kenji; Fujinaga, Hiroyuki; Maruyama, Michiro; Oka, Tôru; Shirayama, Takeshi; Amano, Tetsuya; Fukui, Kazuki; Ando, Kenji; Oshima, Syuichi; Kagiyama, Shuntaro; Teragawa, Hiroki; Yuge, Masaru; Ono, Shiro; Koga, Tomohiro; Fujiu, Katushito; Kuwabara, Masanari; Ohya, Yusuke; Yumoto, Yoshihiro; Kuji, Naomitsu; Ikemura, Makoto; Kario, Kazuomi; Chatani, Kenichi; Sato, Kōichi; Miyagi, Hideki; Murakami, Masaaki; Saito, Kan; Hoshiga, Masaaki; Sato, Shigeo; Kubo, Norifumi; Sakamoto, Yuki; Ashida, Kenki; Sakamoto, Hiroki; Murasaki, Satoshi; Uehara, Hiroki; Akasaka, Takashi; Ooba, Y.; Nakahara, Shiro; Hanaoka, Yohsuke; Nishimiya, Takatoshi; Tsunoda, Ryusuke; Onuma, Yoshinobu; Higuchi, Satoshi; Tani, A. Meziane; Wada, Atsuyuki; Kato, Masafumi; Obata, H; Higuchi, You; Endo, Tsutomu; Katou, R.; Matsunaga, Tomoyuki; Matsuoka, Taka‐aki; Noguchi, Hiroo; Usui, Michio; Hayashi, Takuya; Otsuji, Yutaka; Osaki, Takuya; Zaizen, Hirofumi; Yoshihara, H.; Kadota, Kazushige; Hirose, Tomofumi; Miyazawa, Tsuyoshi; Mori, A; Takano, Masayuki; Shimizu, Wataru; Wake, Minoru; Oriso, Seizo; Yoshiyama, Minoru; Kakinoki, Shigeo; Nishioka, Toshihiko; Ozaki, Tomohiko; Nomoto, Kazumiki; Seki, Kenta; Kawai, Kensuke; Ozaki, Yukio; Miura, Shin-ichiro; Kawasaki, Masayuki; Funada, Ryuichi; Dote, Keigo; Nagano, Tomoya; Okamoto, Sadahisa; Kubo, Takaaki; Murozono, Yukichi; Owada, T.; Doke, Tomohito; Matsumura, T.; Horiuchi, Masataka; Takaishi, Atsushi; Yamamoto, Masashi; Nakashima, Hitoshi; Munemasa, Mitsuru; Sakata, Yasuhiko; Inoue, Naoto; Ota, Terukazu; Hamano, Yuki; Abe, Naoki; Tsubokura, Toshio; Goto, Masaki; Kubota, Isao; Yano, Mariko; Umetani, Ken; Matsumura, Akihiko; Date, Taro; Morimoto, Hideo; Noda, Toshiyuki; Goto, Shinya; Hibi, Kiyoshi; Nakano, Akihiko; Hiramitsu, Shinya; Kihara, Y.; Sugi, Masafumi; Shiba, Nobuyuki; Izumi, Daisuke; Sato, Takanori; Tayama, Shinji; Matsui, Toshiki; Suzuki, A; Ajiki, Kousuke; Oishi, Masayo; Kiryu, Michiro; Ko, Toshinori; Ando, Hisami; Miyazaki, Sakiko; Kinugawa, Toru; Otake, Hiromasa; Kitaoka, Haruko; Hirata, Yoshinori; Honda, Satoshi; Manita, Mamoru; Ishii, Yasuhiro; Oka, Hideki; Nanba, Yoshinobu; Nishino, Masami; Sakamoto, Tsubasa; Saito, Toshinobu; Sakai, Hirotsuka; Ichikawa, Makoto; Namiuchi, Shigeto; Inoue, Kentaro; Komiyama, Nobuyuki; Akashi, Yoshihiro J.; Nakamura, Yuichiro; Komaru, Tatsuya; Hosokawa, Tsunemichi; Chikamori, Taishiro; Tanaka, Hiroyuki; Arasaki, Osamu; Aonuma, Kazutaka; Wakasa, Yutaka; Yoshizawa, Takashi; Sugano, Teruyasu; Yokota, Naomi; Kakutani, Akiyoshi; Suzuki, Takahide; Abe, Yumiko; Kataoka, Toru; Okayama, Hideki; Yokoi, Hiroyoshi; Chin, Kelly; Hasegawa, Koji; Tomita, Hirofumi; Honzyo, H.; Kawai, Hideki; Morino, Yoshihiro; Tsujiyama, Shuji; Hamasaki, Shuichi; Niijima, Yawara; Aoyama, T.; Mizuno, Yusuke; Maki, Akira; Tanabe, Kengo; Murohara, Toyoaki; Nakamura, Taishi; Naomi, Shojiro; Arikawa, Masaya; Kato, Takeshi; Matsumoto, Noriko; Minamino, Tohru; H, Sairenji; Miyamoto, Naomasa; Itô, Hideyuki; Matsuura, Yukiko; Hata, Shiro; Nakatsu, Yusuke; Onodera, Tomoya; Yoshimura, Masataka; Amano, Hidewo; Tokutake, E; Kasao, Masashi; Moriguchi, Masahiko; Yamamoto, Ko; Tsuji, Masayoshi; Yamamoto, Hiroshi; Yanbe, Yuzuru; Iwasawa, Takamasa; Suzuki, Makoto; Mori, Hiromu

doi:10.1016/j.jcin.2021.07.045

Cited by 14 publications

(4 citation statements)

References 19 publications

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“…During the chronic phase of CAD, OAC monotherapy is encouraged based on 2 Japanese randomized studies: the OAC-Alone (Oral Anticoagulation Alone) trial, 19 which demonstrated the non-inferiority of OAC alone relative to combination therapy with an antiplatelet agent for a composite of cardiovascular and bleeding events; and the AFIRE (Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease) trial, which demonstrated the superiority of rivaroxaban monotherapy over combination therapy with rivaroxaban and an antiplatelet agent for both bleeding events and cardiovascular events in patients with stable CAD and AF, from 1 year after PCI. 18 , 36 The percentage of rivaroxaban use also increased after 2020, presumably due to the results of the AFIRE trial. Figure 5B shows that most patients with AF atrial or flutter undergoing PCI have been treated with an antiplatelet-free strategy 12 months after the intervention since 2020.…”

Section: Discussionmentioning

confidence: 99%

Temporal Trends in Antithrombotic Therapy for Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention From 2014 to 2022 in Japan

et al. 2023

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Background: Recent revisions of clinical guidelines by the Japanese Circulation Society, American Heart Association/American College of Cardiology, and European Society of Cardiology updated the management of antithrombotic strategies for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). However, the extent to which these guidelines have been implemented in real-world daily clinical practice is unclear. Methods and Results: We conducted surveys on the status of antithrombotic therapy for patients with AF undergoing PCI every 2 years from 2014 to 2022 in 14 cardiovascular centers in Japan. The primary use of drug-eluting stents increased from 10% in 2014 to 95–100% in 2018, and the use of direct oral anticoagulants increased from 15% in 2014 to 100% in 2018, in accordance with the revised practice guidelines. In patients with acute coronary syndrome, the duration of triple therapy within 1 month was approximately 10% until 2018, and increased to >70% from 2020. In patients with chronic coronary syndrome, the duration of triple therapy within 1 month was approximately 10% until 2016, and >75% from 2018. Since 2020, the most common timing of discontinuation of dual antiplatelet therapy to transition to anticoagulation monotherapy during the chronic phase of PCI has been 1 year after PCI. Conclusions: Japanese interventional cardiologists have updated their treatment strategies for patients with AF undergoing PCI according to revisions of clinical practice guidelines.

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Section: Discussionmentioning

confidence: 99%

Temporal Trends in Antithrombotic Therapy for Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention From 2014 to 2022 in Japan

et al. 2023

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“…However, there have been no studies attempting to analyze whether the benefit of treatment varies with the elapsed time after PCI in RCTs or observational studies. Recently, a post-hoc analysis of AFIRE study including patients who had undergone PCI has been reported which showed that in the PCI subgroup, the main results were consistently observed that rivaroxaban monotherapy was associated with lower risks of the primary efficacy and safety endpoints, compared to combination therapy ( 25 ). The median time from PCI to index date was 48 (IQR, 21–91) months, and most were more than 24 months after PCI.…”

Section: Discussionmentioning

confidence: 99%

Net clinical benefit of antithrombotic therapy for atrial fibrillation patients with stable coronary artery disease

Lee

Jung

Choi

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesTo compare the net clinical benefit of oral anticoagulant (OAC) monotherapy to OAC plus single antiplatelet therapy (SAPT) in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) at 1- and 3-year after percutaneous coronary intervention (PCI).BackgroundIt has not been studied whether the net clinical benefit of the antithrombotic treatment options differs depending on the elapsed time from the index PCI.MethodsUsing the Korean nationwide claims database, we included AF patients who underwent PCI from 2009 to 2019 and constructed two cohorts: 1- and 3-year after PCI. In each cohort, the baseline characteristics of two groups were balanced using propensity score weighting. Ischemic stroke, myocardial infarction, major bleeding, and composite clinical outcomes were analyzed.ResultsAmong patients with 1-year after PCI, OAC monotherapy (n = 678), and OAC plus SAPT (n = 3,159) showed comparable results for all clinical outcomes. In patients with 3-year after PCI, OAC monotherapy (n = 1,038) and OAC plus SAPT (n = 2,128) showed comparable results for ischemic stroke and myocardial infarction, but OAC monotherapy was associated with a lower risk of composite clinical outcomes (HR 0.762, 95% CI 0.607–0.950), mainly driven by the reduction of major bleeding risk (HR 0.498, 95% CI 0.345–0.701).ConclusionOral anticoagulant monotherapy may be a comparable choice for patients with AF and stable CAD compared to OAC plus SAPT. In patients with stable CAD more than 3-year after index PCI, OAC monotherapy would be a better choice, being associated with less major bleeding and a positive net clinical benefit.

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“…On the other hand, DOAC plus antiplatelet therapy was associated with a significantly higher risk of major bleeding compared with DOAC monotherapy (HR 1.61; 95% CI, 1.38–1.87), as well as higher risk of net adverse events (NAE) (HR, 1.21; 95% CI, 1.02–1.43). Although these results were the main data we found in this scenario, we must take into account the methodological limitations of the AFIRE study and the premature stopping of the trial due to an increase in mortality in the combination therapy arm in the interpretation of the results [ 63 , 64 ].…”

Section: Patients With Af and Coronary Artery Diseasementioning

confidence: 99%

Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

Bonanad

Esteve-Claramunt

García‐Blas

et al. 2022

JCM

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The treatment of acute coronary syndrome (ACS) in elderly patients continues to be a challenge because of the characteS.G.B.ristics of this population and the lack of data and specific recommendations. This review summarizes the current evidence about critical points of oral antithrombotic therapy in elderly patients. To this end, we discuss the peculiarities and differences reported referring to dual antiplatelet therapy (DAPT) in ACS management in elderly patients and what might be the best option considering these population characteristics. Furthermore, we analyze antithrombotic strategies in patients with atrial fibrillation (AF), with a particular focus on those cases that also present coronary artery disease (CAD). It is imperative to deepen our knowledge regarding the management of these challenging patients through real-world data and specifically designed geriatric studies to help resolve the questions remaining in their disease management.

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Rivaroxaban Monotherapy in Patients With Atrial Fibrillation After Coronary Stenting

Cited by 14 publications

References 19 publications

Temporal Trends in Antithrombotic Therapy for Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention From 2014 to 2022 in Japan

Temporal Trends in Antithrombotic Therapy for Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention From 2014 to 2022 in Japan

Net clinical benefit of antithrombotic therapy for atrial fibrillation patients with stable coronary artery disease

Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes

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