Key result
Apixaban is superior to vitamin K antagonists for stroke prevention in atrial fibrillation and appears safe and effective when combined with a P2Y12 inhibitor in patients with concomitant ACS.
Why the study?
In patients with AF and concomitant ACS, combined regimens of NOACs and P2Y12 inhibitors are gaining popularity, prompting an overview of apixaban safety, effectiveness, and tolerability.
Is apixaban safe and effective for the treatment of atrial fibrillation and acute coronary syndrome, alone or combined with antiplatelet therapy?
Is apixaban safe and effective for the treatment of atrial fibrillation and acute coronary syndrome, alone or combined with antiplatelet therapy?
Apixaban is a safe and effective alternative to VKA for stroke prevention in AF, and its combination with a P2Y12 inhibitor is a viable strategy for patients with both AF and ACS.
Answers are grounded in this paper and cite their sources.
Apixaban regimens may be considered in AF with ACS; leaves open optimal strategy pending dedicated trials.
Introduction: The non-vitamin K antagonist oral anticoagulants (NOACs) are changing the landscape for stroke prevention in atrial fibrillation (AF) and prevention or treatment of venous thromboembolism (VTE). In patients with AF and concomitant acute coronary syndrome (ACS), the treatment regimen of combined NOACs and P2Y12 inhibitors is gaining popularity.Areas covered: We conducted a review of safety evaluation and effectiveness of apixaban for AF and ACS treatment, both alone and in combination with different antiplatelet treatment regimens. The aim was to provide an overview of apixaban including mechanism of action, indications, adverse events and tolerability.Expert opinion: Apixaban is recommended as a safe, well tolerated and effective oral anticoagulant for reducing the risk of ischemic events among AF patients. It is of value in prevention and treatment of VTE and pulmonary embolism. Comparing to VKA, apixaban was superior in preventing stroke or systemic embolism with lower major bleeding events among AF patients. When combined with dual antiplatelet therapy apixaban may cause dose-related increase in bleeding which reduces the benefit of this treatment regimen among ACS patients but without AF. In those with ACS and concomitant AF, the combination of apixaban with P2Y12 inhibitor appears to be safe and effective.
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Gumprecht et al. (2019) conducted a review in Atrial fibrillation and acute coronary syndrome. Apixaban vs. Vitamin K antagonists was evaluated. Apixaban is superior to vitamin K antagonists for stroke prevention in atrial fibrillation and appears safe and effective when combined with a P2Y12 inhibitor in patients with concomitant ACS.
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