Apixaban in patients with atrial fibrillation and acute coronary syndrome in elective percutaneous coronary intervention: what did the subanalysis of the AUGUSTUS trial add to our understanding?

Abstract

The article is devoted to the results of the subanalysis published after release of the AUGUSTUS trial. The most important conclusion of the parent trial is the evidence that weekly aspirin therapy is sufficient to prevent thrombotic complications in the majority of patients with AF and ACS, as well as those undergoing elective PCI, and that aspirin therapy can be extended up to 1 month after PCI only in a part of patients with additional risk factors for ischemic events and a low risk of bleeding. Four years have passed since the publication of the AUGUSTUS trial results, and all subsequent subanalyses of the trial confirmed its results. The safety and efficacy advantages of apixaban over warfarin were shown to be independent of renal function and consistent with the overall trial results. The advantages of apixaban and the association of aspirin with bleeding were similar in both stroke and non-stroke patients with AF and were dose-independent when a dose was reduced to 2.5 mg twice in accordance with the reduction criteria. The advantages of apixaban over warfarin lasted regardless of time spent in the therapeutic range in the warfarin group. The advantages of apixaban over warfarin and the association of long-term intake of aspirin with bleeding rates persisted in patients with high and low baseline risk of bleeding and stroke. All subanalyses of the AUGUSTUS trial confirmed the efficacy and safety of apixaban, as well as the option to discontinue aspirin at the outpatient stage in the majority of patients with AF, who underwent elective PCI or ACS.