Some nuances of management of antiplatelet therapy in patients with acute coronary syndrome and atrial fibrillation using apixaban

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Antiplatelet therapy in patients with atrial fibrillation (AF) and acute coronary syndrome is associated with complex decisions regarding the duration of “triple” therapy, choice of one from oral anticoagulants, and other factors. Clinical trial data show that although patients should receive “triple” therapy after percutaneous coronary intervention and stenting, its duration should be minimized by switching to a direct oral anticoagulant plus P2Y12 inhibitor. AUGUSTUS study demonstrated that early (approximately 7 days after percutaneous coronary intervention) switching from “triple” antiplatelet therapy to apixaban (in the usual dose for AF) and P2Y12 inhibitor should be the strategy of choice in many patients. This article discusses some of the nuances of managing patients with acute coronary syndrome and AF with a high risk of bleeding and/or high ischemic risk. Choosing apixaban as a first-line remedy for such kind of patients, its favorable efficacy and safety profile, even in case of high hemorrhagic and/or ischemic risk is justified.

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Alexey Erlikh

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia (Pirogov University); Ilyinsky Hospital

编辑信件的主要联系方式.
Email: alexeyerlikh@gmail.com
ORCID iD: 0000-0003-0607-2673
SPIN 代码: 4697-0822

MD, Dr. Sci. (Medicine), professor of the Department of faculty therapy of the Institute of clinical medicine, head of the Department of cardiology

俄罗斯联邦, Moscow; Moscow region

Sergey Terekhin

Ilyinsky Hospital

Email: s.terekhin@ihospital.ru
ORCID iD: 0000-0002-3854-2206

MD, PhD (Medicine), head of the Department of X-ray endovascular diagnostics and treatment

俄罗斯联邦, Moscow region

Sergey Shornikov

Ilyinsky Hospital

Email: s.shornikov@ihospital.ru
ORCID iD: 0000-0003-4896-6851

MD, cardiologist

俄罗斯联邦, Moscow region

参考

  1. Lehto M, Snapinn S, Dickstein K, Swedberg K, Nieminen MS; OPTIMAAL investigators. Prognostic risk of atrial fibrillation in acute myocardial infarction complicated by left ventricular dysfunction: The OPTIMAAL experience. Eur Heart J. 2005;26(4):350–56. PMID: 15618041. https://doi.org/10.1093/eurheartj/ehi064
  2. Batra G, Svennblad B, Held C, Jernberg T, Johanson P, Wallentin L, Oldgren J. All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome. Heart. 2016;102(12):926–33. PMID: 26928408. https://doi.org/10.1136/heartjnl-2015-308678
  3. Luo J, Li H, Qin X, Liu B, Zhao J, Maihe G et al. Increased risk of ischemic stroke associated with new-onset atrial fibrillation complicating acute coronary syndrome: A systematic review and meta-analysis. Int J Cardiol. 2018;265:125–31. PMID: 29706432. https://doi.org/10.1016/j.ijcard.2018.04.096
  4. Lamberts M, Olesen JB, Ruwald MH, Hansen CM, Karasoy D, Kristensen SL et al. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention: A nationwide cohort study. Circulation. 2012;126(10):1185–93. PMID: 22869839. https://doi.org/10.1161/CIRCULATIONAHA.112.114967
  5. van Rein N, Heide-Jorgensen U, Lijfering WM, Dekkers OM, Sorensen HT, Cannegieter SC. Major bleeding rates in atrial fibrillation patients on single, dual, or triple antithrombotic therapy. Circulation. 2019;139(6):775–86. PMID: 30586754. https://doi.org/10.1161/CIRCULATIONAHA.118.036248
  6. Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: A systematic review of the incidence, clinical features and prognostic implications. Eur Heart J. 2009;30(9):1038–45. PMID: 19109347. https://doi.org/10.1093/eurheartj/ehn579
  7. Bazoukis G, Man Ho Hui J, Saplaouras A, Efthymiou P, Vassiliades A, Dimitriades V et al. The impact of new-onset atrial fibrillation in the setting of acute coronary syndrome. J Cardiol. 2025;85(3):186–203. PMID: 39788318. https://doi.org/10.1016/j.jjcc.2024.12.007
  8. Dewilde W, Oirbans T, Verheugt F, Kelder JC, De Smet B, Herrman J-P et al.; WOEST study investigators. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: An open-label, randomised, controlled trial. Lancet. 2013;381(9872):1107–15. PMID: 23415013. https://doi.org/10.1016/S0140-6736(12)62177-1
  9. Gibson М, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 2016;375(25):2423–34. PMID: 27959713. https://doi.org/10.1056/NEJMoa1611594
  10. Cannon CP, Bhatt DL, Oldgren J, Lip G, Ellis SG, Kimura T et al.; RE-DUAL PCI Steering Committee and Investigators. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. Engl J Med. 2017;377(16):1513–24. PMID: 28844193. https://doi.org/10.1056/NEJMoa1708454
  11. Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R et al.; AUGUSTUS Investigators. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med. 2019;380(16):1509–24. PMID: 30883055. https://doi.org/10.1056/NEJMoa1817083
  12. Berwanger O, Wojdyla DM, Fanaroff AC, Budaj A, Granger CB, Mehran R et al. Antithrombotic strategies in atrial fibrillation after ACS and/or PCI: A 4-way comparison from AUGUSTUS. J Am Coll Cardiol. 2024;84(10):875–85. PMID: 39197976. https://doi.org/10.1016/j.jacc.2024.06.022
  13. Gargiulo G, Goette A, Tijssen J, Eckardt L, Lewalter T, Vranckx P, Valgimigli M. Safety and efficacy outcomes of double vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulant-based randomized clinical trials. Eur Heart J. 2019;40(46):3757–67. PMID: 31651946. https://doi.org/10.1093/eurheartj/ehz732
  14. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720–26. PMID: 37622654. https://doi.org/10.1093/eurheartj/ehad191
  15. Клинические рекомендации. Острый инфаркт миокарда с подъемом сегмента ST электрокардиограммы. Ассоциация сердечно-сосудистых хирургов России, общероссийская общественная организация «Российское кардиологическое общество», Российское научное общество специалистов по рентгенэндоваскулярной диагностике и лечению, общероссийская общественная организация «Российское общество скорой медицинской помощи». Рубрикатор клинических рекомендаций Минздрава России. 2024. ID: 157_5. Доступ: https://cr.minzdrav.gov.ru/view-cr/157_5 (дата обращения – 21.08.2025). [Clinical guidelines. Acute myocardial infarction with ST-segment elevation of the electrocardiogram. Association of Cardiovascular Surgeons of Russia, Russian Society of Cardiology, Russian Scientific Society of Specialists in X-ray Endovascular Diagnostics and Treatment, Russian Society of Emergency Medical Care. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2024. ID: 157_5. URL: https://cr.minzdrav.gov.ru/view-cr/157_5 (date of access – 21.08.2025) (In Russ.)].
  16. Rao SV, O’Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: A report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771–e862. PMID: 40014670. https://doi.org/10.1161/CIR.0000000000001309
  17. Ganse EV, Danchin N, Mahe I, Hanon O, Jacoud F, Nolin M et al. Comparative safety and effectiveness of oral anticoagulants in nonvalvular atrial fibrillation. The NAXOS study. Stroke. 2020;51(7):2066–75. PMID: 32539675. PMCID: PMC7306262. https://doi.org/10.1161/STROKEAHA.120.028825
  18. Lau W, Torre CO, Man K, Stewart HM, Seager S, Zandt MV et al. Comparative effectiveness and safety between apixaban, dabigatran, edoxaban, and rivaroxaban among patients with atrial fibrillation: A multinational population-based cohort study. Ann Intern Med.2022;175(11):1515–24. PMID: 36315950. https://doi.org/10.7326/M22-0511
  19. Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention. Circulation. 2019;140(3):240–61. PMID: 31116032. PMCID: PMC6636810. https://doi.org/10.1161/CIRCULATIONAHA.119.040167
  20. Angiolillo DJ, Bhatt DL, Cannon CP, Eikelboom JW, Gibson CM, Goodman SG et al. Antithrombotic therapy in patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention: A North American Perspective: 2021 update. Circulation. 2021;143(6):583–96. PMID: 33555916. https://doi.org/10.1161/CIRCULATIONAHA.120.050438

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2. Fig. The frequency of adverse events in patients in the AUGUSTUS study (A - large/small clinically significant bleeding; B - death + hospitalization) [11]

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