Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI

• Published in: The New England journal of medicine Vol. 375; no. 25; pp. 2423 - 2434
• Main Authors: Gibson, C. Michael, Mehran, Roxana, Bode, Christoph, Halperin, Jonathan, Verheugt, Freek W, Wildgoose, Peter, Birmingham, Mary, Ianus, Juliana, Burton, Paul, van Eickels, Martin, Korjian, Serge, Daaboul, Yazan, Lip, Gregory Y.H, Cohen, Marc, Husted, Steen, Peterson, Eric D, Fox, Keith A
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 22.12.2016
• Subjects: Aged; Angioplasty; Anticoagulants; Antiplatelet therapy; Aspirin; Atrial Fibrillation - drug therapy; Atrial Fibrillation - therapy; Bleeding; Cardiac arrhythmia; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cerebral infarction; Clinical significance; Coagulation; Confidence Intervals; Drug Therapy, Combination; Factor Xa Inhibitors - administration & dosage; Factor Xa Inhibitors - adverse effects; Female; Fibrillation; Hemorrhage - chemically induced; Hemorrhage - prevention & control; Humans; Implants; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial infarction; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Purinergic P2Y Receptor Antagonists - adverse effects; Purinergic P2Y Receptor Antagonists - therapeutic use; Rivaroxaban - administration & dosage; Rivaroxaban - adverse effects; Stents; Stroke; Thrombolysis; Thrombosis; Vitamin K; Vitamin K - antagonists & inhibitors
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1611594

This trial compared standard therapy (dual antiplatelet therapy plus a vitamin K antagonist) with two regimens containing rivaroxaban plus antiplatelet therapy. The rivaroxaban groups had reduced rates of bleeding and similar efficacy in preventing cardiovascular events. Approximately 5 to 8% of patients who undergo percutaneous coronary intervention (PCI) have atrial fibrillation. 1 – 3 Dual antiplatelet therapy (DAPT) with a P2Y 12 inhibitor and aspirin is superior to oral anticoagulation with a vitamin K antagonist in reducing the risk of thrombosis in patients undergoing placement of a first-generation stent, 4 but oral anticoagulation is superior to DAPT in reducing the risk of ischemic stroke in patients with atrial fibrillation. 5 The treatment strategy for patients with atrial fibrillation who have received stents must balance the risk of stent thrombosis and ischemic stroke with the risk of bleeding. A common guideline-supported . . .