Antithrombotic Therapy for Atrial Fibrillation and Coronary Artery Disease in Patients With Prior Atherothrombotic Disease: A Post Hoc Analysis of the AFIRE Trial

Figures

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  Figure 1. Participant flow. Patients were randomized (1:1) to receive either rivaroxaban monotherapy or combination therapy with rivaroxaban plus antiplatelet drug. For the purpose of this study, AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) participants were divided into 2 subgroups, including the atherothrombosis group (patients with prior myocardial infarction, stroke, and/or peripheral artery disease) and the non‐atherothrombosis group.

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  Figure 2. Kaplan‐Meier curves between the non‐atherothrombosis and atherothrombosis groups. The atherothrombosis group consisted of patients with prior myocardial infarction, stroke, or peripheral artery disease. A, The primary efficacy end point was a composite of cardiovascular events or all‐cause mortality, while (B) the primary safety end point was major bleeding as defined based on criteria established by the International Society on Thrombosis and Haemostasis. C, Net adverse clinical events consisted of death from any cause, myocardial infarction, stroke, and major bleeding. HR indicates hazard ratio.

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  Figure 3. Kaplan‒Meier curves for prior atherothrombotic disease and treatment group. Kaplan–Meier curves for (A) the primary efficacy entpoint, (B) primary safety end point, and (C) net clinical adverse events (4 groups, based on the non‐atherothrombosis/atherothrombosis group and treatment type). Interaction P is for group (non‐atherothrombosis or atherothrombosis)×interventions (monotherapy or combination therapy). Combi indicates combination therapy; HR, hazard ratio; and Mono, monotherapy

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  Figure 4. Supposed relationship between antithrombotic therapy strength and risk of ischemic and bleeding events. A, Non‐atherothrombosis group; (B) atherothrombosis group. Red lines indicate bleeding event risk, while blue lines indicate ischemic event risk. Bleeding risk was higher in the atherothrombosis group than in the non‐atherothrombosis group, as seen from the right edge of the figures (no antithrombotic therapy). The red line for bleeding risk in the atherothrombosis group rises more steeply than that of the non‐atherothrombosis group. Thus, the optimal “therapeutic window” (green area in the figures) may be narrower and of lesser range in the atherothrombosis group. DOAC indicates direct oral anticoagulant; and SAPT, single antiplatelet therapy.