"Anticoagulation + anti-platelet therapy-2, something you could not think of during warfarin"


"This AUGUSTUS study from Eliquis showed that the risk of NOAC versus warfarin bleeding is reduced, as well as acute phase 3 therapy for patients with atrial fibrillation with acute coronary syndrome (ACS) / percutaneous coronary intervention (PCI) 2 have suggested a strong base to support the transition to therapy. "

Professor, Department of Cardiology, Seoul National University Hospital

Professor Kang Hyun Jae of the Department of Cardiology, Seoul National University Hospital, explained the clinical significance of the AUGUSTUS study at a press conference held at Eliquis & # 39; (name of the Apixaban ingredient) at the Courtyard Marriott Seoul, Namdaemun Hotel on the 15th.

The AUGUSTUS study was conducted in 4,614 patients with acute myocardial infarction (ACS) with coronary artery disease (PCI) undergoing PCI or regardless of the method of treatment with Eliquis and vitamin K antagonists (warfarin), aspirin, and placebo. Multinational clinical trial , multicenter, prospective, randomized 2 x 2 study for comparison of bleeding or clinically significant non-significant bleeding outcomes.

Therapy is defined as the addition of an aspirin or P2Y12 inhibitor to oral anticoagulants and the addition of aspirin and a P2Y12 inhibitor is defined as a & quot; triple therapy & quot ;.

According to the Guidelines for Atrial Fibrillation in 2018, the use of antiplatelet agents and oral anticoagulants (NOAC or warfarin) should be used in patients with coronary artery disease and atrial fibrillation. However, the guidelines recommend that long-term triple therapy be avoided, since the addition of antiplatelet agents to oral anticoagulants will inevitably increase the risk of bleeding. Therefore, it was left to the academic community to decide when to go for 3-therapy.

The AUGUSTUS study included a comparison between NOAC and vitamin K antagonists (warfarin) as anticoagulants in the treatment of anticoagulant + antiplatelet anticoagulant (clopidogrel + aspirin) + anticoagulant E if they could maintain the risk of bleeding and efficacy by therapy.

As a result, in patients receiving the P2Y12 inhibitor (clopidogrel) regardless of double or single antiplatelet therapy, the Eliquis treatment group reduced the risk of a bleeding event by 31% at 6 months of treatment compared to the treatment group with warfarin.

In addition, the proportion of patients with major bleeding or clinically significant unimportant bleeding at 6 months was significantly higher in patients treated with triple therapy, including aspirin, regardless of Eliquis and warfarin, compared to regimens of 2 therapies.

In contrast, NOAC reduced the risk of bleeding from anticoagulant + platelet aggregation in patients with atrial fibrillation associated with ACS / PCI in 31% and was independently associated with non-aspirin anticoagulant (NOAC or warfarin) plus antiplatelet therapy (clopidogrel) 2 Therapy has been shown to reduce the risk of bleeding compared to triple therapy but to remain effective.

"The number of patients with percutaneous coronary intervention has steadily increased from 2,140 in 2006 to 3,631 in 2015, regardless of sex," said Professor Kang Hyun-jae of the Seoul National University Hospital. The data show that there are a considerable number of AUGUSTUS patients in the country, but the number of patients treated with anticoagulant plus platelet aggregation is low because of the potential risk of potential bleeding. "

"This AUGUSTUS study demonstrated once again that NOAC reduces the risk of bleeding compared to warfarin as well as early treatment of patients with atrial fibrillation with ACS / PCI." Clopidogrel + aspirin + anticoagulant "" It is a strong basis to prove that treatment with clopidogrel and Eliques® alone can reduce the risk of bleeding and still maintain its therapeutic effect. "

Professor Kang emphasized, "In the warfarin era, as the use of NOAC becomes more common, the guideline is changing to minimize the risk of bleeding, and this AUGUSTUS study is a powerful clinical outcome." Currently, patients with atrial fibrillation accompanied by ACS / ICPs are at increased risk of bleeding during the first month, but the current scheme of three therapies is being used, but it is expected to be gradually switched to bipolar therapy and sooner, "he said.

Kim Yoon My reporter [email protected]

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