Apixaban and Limiting Aspirin for Patients With Atrial Fibrillation, Percutaneous Coronary Intervention, and Multimorbidity.
| Autor: | Krychtiuk KA; Duke Clinical Research Institute, Durham, North Carolina, USA., Lopes RD; Duke Clinical Research Institute, Durham, North Carolina, USA.; Division of Cardiology, Duke Health, Durham, North Carolina, USA., Wojdyla DM; Duke Clinical Research Institute, Durham, North Carolina, USA., Goodman SG; Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.; Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Ontario, Canada., Aronson R; Bristol-Myers Squibb, Lawrenceville, New Jersey, USA., Windecker S; Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland., Mehran R; Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, and Cardiovascular Research Foundation, New York, New York, USA., Granger CB; Duke Clinical Research Institute, Durham, North Carolina, USA.; Division of Cardiology, Duke Health, Durham, North Carolina, USA., Alexander JH; Duke Clinical Research Institute, Durham, North Carolina, USA.; Division of Cardiology, Duke Health, Durham, North Carolina, USA., Alexander KP; Duke Clinical Research Institute, Durham, North Carolina, USA.; Division of Cardiology, Duke Health, Durham, North Carolina, USA. |
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| Jazyk: | angličtina |
| Zdroj: | JACC. Advances [JACC Adv] 2024 Oct 17; Vol. 3 (11), pp. 101335. Date of Electronic Publication: 2024 Oct 17 (Print Publication: 2024). |
| DOI: | 10.1016/j.jacadv.2024.101335 |
| Abstrakt: | Background: Patients with atrial fibrillation (AF) after an acute coronary syndrome (ACS) and/or undergoing percutaneous coronary intervention (PCI) with multiple comorbidities are at increased risk for bleeding and ischemic events. Objectives: This post-hoc analysis of AUGUSTUS describes the safety and efficacy of antithrombotic regimens in patients with multimorbidity. Methods: AUGUSTUS was a 2 × 2 factorial, randomized controlled trial evaluating the safety of apixaban vs vitamin K antagonists (VKA) (open-label) and aspirin vs placebo (double-blind) in patients with AF and ACS and/or PCI treated with a P2Y Results: Of 4,493 patients (97.4%) with available comorbidity data, 1,897 (42.2%) had no multimorbidity, 2,110 (47%) had moderate, and 486 (10.8%) had high multimorbidity. Patients with moderate (HR: 1.23; 95% CI: 1.02-1.47) and high (HR: 1.98; 95% CI: 1.55-2.54) multimorbidity had higher rates of International Society on Thrombosis and Haemostasis (ISTH) major or clinically relevant nonmajor (CRNM) bleeding compared to patients with no multimorbidity. No significant interaction between multimorbidity and apixaban vs vitamin K antagonists was observed for ISTH major bleeding/CRNM ( P Conclusions: Our findings support the standard use of apixaban plus a P2Y Competing Interests: The AUGUSTUS trial and this analysis were supported by Bristol Myers Squibb and 10.13039/100004319Pfizer. Dr Krychtiuk was supported by a research grant from the 10.13039/100015330Max Kade Foundation/10.13039/501100001822Austrian Academy of Science. Dr Krychtiuk has received speaker fees from Daiichi Sankyo and Zoll Medical; consulting fees from Amarin, Novartis, and Sanofi; and travel support from 10.13039/100002429Amgen and 10.13039/100004339Sanofi. Dr Lopes has received research grants or contracts from Amgen, Bristol-Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi-Aventis; funding for educational activities or lectures from Pfizer, Daiichi Sankyo, and Novo Nordisk; and funding for consulting or other services from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, and Novo Nordisk. Dr Goodman has received research grant support (eg, steering committee or data and safety monitoring committee) and/or speaker/consulting honoraria (eg, advisory boards) from Amgen, Anthos Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, CYTE Ltd, Daiichi-Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, HLS Therapeutics, Idorsia, JAMP Pharma, Merck, Novartis, Novo Nordisk A/C, Pendopharm/Pharmascience, Pfizer, Regeneron, Sanofi, Servier, Tolmar Pharmaceuticals, Valeo Pharma; and salary support/honoraria from the Heart and Stroke Foundation of Ontario/University of Toronto (Polo) Chair, Canadian Heart Failure Society, Canadian Heart Research Centre and MD Primer, Canadian VIGOUR Centre, Cleveland Clinic Coordinating Centre for Clinical Research, Duke Clinical Research Institute, New York University Clinical Coordinating Centre, PERFUSE Research Institute, and TIMI Study Group (Brigham Health). Dr Aronson is an employee of Bristol Myers Squibb. Dr Windecker has received research, travel, or educational grants to the institution without personal remuneration from Abbott, Abiomed, Amgen, Astra Zeneca, Bayer, Braun, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardinal Health, CardioValve, Cordis Medical, Corflow Therapeutics, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Farapulse Inc, Fumedica, Guerbet, Idorsia, Inari Medical, InfraRedx, Janssen-Cilag, Johnson & Johnson, Medalliance, Medicure, Medtronic, Merck Sharp & Dohm, Miracor Medical, MonarQ, Novartis, Novo Nordisk, Organon, OrPha Suisse, Pharming Tech, Pfizer, Polares, Regeneron, Sanofi-Aventis, Servier, Sinomed, Terumo, Vifor, and V-Wave. Dr Windecker served as an advisory board member and/or member of the steering/executive group of trials funded by 10.13039/100000046Abbott, 10.13039/100020297Abiomed, 10.13039/100002429Amgen, Astra Zeneca, 10.13039/100004326Bayer, 10.13039/100008497Boston Scientific, 10.13039/501100005035Biotronik, Bristol Myers Squibb, 10.13039/100006520Edwards Lifesciences, 10.13039/501100023518MedAlliance, 10.13039/100004374Medtronic, 10.13039/100004336Novartis, Polares, Recardio, Sinomed, 10.13039/501100008645Terumo, and V-Wave with payments to the institution but no personal payments; and he is a member of the steering/executive committee group of several investigator-initiated trials that receive funding from industry without impacting his personal remuneration. Dr Mehran has received institutional research payments from: Abbott, Abiomed, Affluent Medical, Alleviant Medical, Amgen, AM-Pharma, Arena, AstraZeneca, AtriCure Inc, Biosensors, Biotronik, Boston Scientific, Bristol-Myers Squibb, CardiaWave, CeloNova, CERC, Chiesi, Concept Medical, Cytosorbents, Daiichi Sankyo, Duke, Element Science, Essential Medical, Faraday, Idorsia Pharmaceuticals, Janssen, MedAlliance, Mediasphere, Medtelligence, Medtronic, MJH Healthcare, Novartis, OrbusNeich, Penumbra, PhaseBio, Philips, Pi-Cardia, PLx Pharma, Population Health Research Institute, Protembis, RecCor Medical Inc, RenalPro, RM Global, Sanofi, Shockwave, Vivasure, Zoll; personal fees from Cardiovascular Research Foundation (CRF), Cordis, Daiichi Sankyo Brasil, E.R. Squibb & Sons, Esperion Science/Innovative Biopharma, Europa Group/Boston Scientific, Gaffney Events, Educational Trust, Henry Ford Health Cardiology, Ionis Pharmaceuticals, MedCon International, Novartis, NovoNordisk, PeerView Institute for Medical Education, TERUMO Europe N.V., Vectura, VoxMedia, WebMD, IQVIA, Radcliffe, and TARSUS Cardiology; no fees from AMA (Scientific Advisory Board) and SCAI (Women in Innovations Committee Member); and Faculty CRF Honorarium: JAMA Cardiology (Associate Editor) and ACC (BOT Member, SC Member CTR Program). Dr Granger has received consulting fees from Abbvie, Abiomed, Alnylam, Anthos, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardionomic, Celecor Therapeutics, Hengrui USA, Janssen, Medscape, Medtronic, Merck, NephroSynergy, Novo Nordisk, NIH, Novartis, Pfizer, Philips, REATA, Roche, and Veralox Therapeutics Inc; grants/contracts from Alnylam, Boehringer Ingelheim, Bristol Myers Squibb, Duke Clinical Research Institute, FDA, Janssen, Lilly, Novartis, Pfizer, and Philips; equity from Tenac.io. Dr Alexander has received research grants through Duke University from Artivion/CryoLife, Bayer, Bristol-Myers Squibb, CSL Behring, Ferring, the U.S. FDA, Humacyte, and the U.S. NIH, and advisory board or consulting payments from AbbVie, Akros, Artivion/CryoLife, AtriCure, Bayer, Bristol-Myers Squibb, Ferring, GlaxoSmithKline, Janssen, Novostia, Pfizer, Portola, Theravance, and Veralox. (© 2024 The Authors.) |
| Databáze: | MEDLINE |
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