Fast Five Quiz: Atrial Fibrillation and Acute Coronary Syndrome

Sandeep K. Goyal, MD


March 10, 2022

Head-to-head randomized trials comparing the different P2Y12 inhibitors as part of combination antithrombotic therapy have not been conducted. Most trials of combination antithrombotic therapy used clopidogrel; some others used ticagrelor or prasugrel.

Most experts agree that aspirin therapy is not beneficial for patients with AF who are at low risk for thrombotic events. In patients at intermediate risk, risk factors for thromboembolic disease, patient preference, bleeding risk, fall and trauma risk, and likelihood of medication adherence should be considered when making treatment decisions regarding anticoagulant use.

An antithrombotic regimen comprising a P2Y12 inhibitor and a factor Xa inhibitor without aspirin has been shown to reduce bleeding risk in patients with AF and ACS. In the AUGUSTUS trial, this combination resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a vitamin K antagonist, aspirin, or both, in patients with AF and a recent ACS or percutaneous coronary intervention.

Low body weight is among the factors to consider when considering bleeding risk in individual patients. Others include age, history of bleeding, chronic kidney disease, chronic obstructive pulmonary disease, previous stroke/transient ischemic attack, male sex, anemia diagnosed during the last 12 months, heart failure, hypertension, and nonbleeding-related hospital admission during the last 12 months.

Learn more about the treatment of patients with AF and ACS.


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