{"id":"18be7e958ad8","type":"article","url":"https://hartvaat.nl/2019/04/18/antitrombotische-therapie-na-acs-of-pci-bij-af-nejm-augustus/","title":"Antitrombotische therapie na ACS of PCI bij AF: NEJM AUGUSTUS","title_en":"Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1817083","source_url":"https://doi.org/10.1056/NEJMoa1817083","authors":["Renato D Lopes","Gretchen Heizer","Ronald Aronson","Amit N Vora","Tyler Massaro","Roxana Mehran","Shaun G Goodman","Stephan Windecker","Harald Darius","Jia Li","Oleg Averkov","M Cecilia Bahit","Otavio Berwanger","Andrzej Budaj","Ziad Hijazi","Alexander Parkhomenko","Peter Sinnaeve","Robert F Storey","Holger Thiele","Dragos Vinereanu","Christopher B Granger","John H Alexander"],"significance":10,"published":"2019-04-18","source_date":"2019-04-18","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The AUGUSTUS trial, using a 2×2 factorial design, demonstrated that apixaban was superior to warfarin (less bleeding) and aspirin offered no ischemic benefit over placebo in patients with atrial fibrillation after ACS or PCI. This trial definitively established dual therapy with a DOAC plus a P2Y12 inhibitor as the preferred antithrombotic strategy.","created":"2026-07-03T10:27:53Z","updated":"2026-07-03T13:27:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM AUGUSTUS-trial — 2x2 factorieel: apixaban vs VKA en aspirine vs placebo bij AF-patiënten met ACS of PCI. Definitieve trial voor het duale versus triple therapiedebat.","abstract_original":"BACKGROUND: Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. METHODS: In an international trial with a two-by-two factorial design, we randomly assigned patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y12 inhibitor to receive apixaban or a vitamin K antagonist and to receive aspirin or matching placebo for 6 months. The primary outcome was major or clinically relevant nonmajor bleeding. Secondary outcomes included death or hospitalization and a composite of ischemic events. RESULTS: Enrollment included 4614 patients from 33 countries. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. Major or clinically relevant nonmajor bleeding was noted in 10.5% of the patients receiving apixaban, as compared with 14.7% of those receiving a vitamin K antagonist (hazard ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.81; P<0.001 for both noninferiority and superiority), and in 16.1% of the patients receiving aspirin, as compared with 9.0% of those receiving placebo (hazard ratio, 1.89; 95% CI, 1.59 to 2.24; P<0.001). Patients in the apixaban group had a lower incidence of death or hospitalization than those in the vitamin K antagonist group (23.5% vs. 27.4%; hazard ratio, 0.83; 95% CI, 0.74 to 0.93; P = 0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group. CONCLUSIONS: In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in the incidence of ischemic events than regimens that included a vitamin K antagonist, aspirin, or both. (Funded by Bristol-Myers Squibb and Pfizer; AUGUSTUS ClinicalTrials.gov number, NCT02415400.)."}