Triple Therapy With Rivaroxaban in Patients With Acute Myocardial Infarction and Prior Atrial Fibrillation

Background Current guidelines recommend the use of combined oral anticoagulants and antiplatelet agents in patients with acute myocardial infarction (AMI) and atrial fibrillation (AF), especially for those at high risk. In real‐world clinical practice, adherence to anticoagulant therapy is often suboptimal, and some patients do not routinely receive it. Methods Patients diagnosed with AMI and AF who were prescribed dual antiplatelet drugs in Tianjin, China, from August 2016 to June 2023 were enrolled. The primary outcomes were stroke, ischemic stroke, and hemorrhagic stroke. Results A total of 1,026 patients were identified (mean age: 73.7, standard deviation: 9.12; 39% female), which included 132 rivaroxaban users and 894 non‐users. Over a median follow‐up of 922 days, 298 patients died and 367 patients suffered from stroke. After adjusting for multiple variables, rivaroxaban users had a lower risk of any stroke (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.43–0.90) and ischemic stroke (HR, 0.63; 95% CI, 0.43–0.92), compared to non‐users. In the propensity matched cohort, rivaroxaban users had a lower risk of stroke and ischemic stroke with no significant difference in bleeding or major bleeding. Multivariable competing risk models were consistent with the above results. No statistically significant association was found for rivaroxaban use and bleeding, major bleeding, all‐cause mortality, or cardiovascular mortality. Conclusions Concomitant rivaroxaban use is associated with lower risks of stroke, especially ischemic stroke, but with no significant increase in the risks of bleeding and major bleeding in patients with AMI and preexisting AF taking dual antiplatelet drugs. Trial registration Registration number: ChiCTR2400094021