Why the study?
Does apixaban (reduced or standard dose) reduce bleeding and prevent ischemic outcomes compared to VKA in patients with atrial fibrillation and recent ACS or PCI?
Does apixaban (reduced or standard dose) reduce bleeding and prevent ischemic outcomes compared to VKA in patients with atrial fibrillation and recent ACS or PCI?
In patients with AF and recent ACS or PCI, both appropriately reduced and standard dose apixaban are associated with lower bleeding risk and similar ischemic outcomes compared to VKA.
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Supports preferring apixaban over VKA for lower bleeding with similar ischemia in AF post-ACS/PCI; challenges prior low-certainty evidence against benefit.
Of the ∼10% of patients in AUGUSTUS who received reduced dose apixaban, less than one-half met the dose-reduction criteria. In patients with AF and recent ACS or PCI, appropriately reduced dose apixaban was associated with a lower risk of bleeding and similar rates of ischemic outcomes compared with VKA, similar results were found with standard dose apixaban. (A Study of Apixaban in Patients With Atrial Fibrillation, Not Caused by a Heart Valve Problem, Who Are at Risk for Thrombosis [Blood Clots] Due to Having Had a Recent Coronary Event, Such as a Heart Attack or a Procedure to Open the Vessels of the Heart; NCT02415400).
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Fudim et al. (2025) studied this question.
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