# AUGUSTUS 4-weg vergelijking: antitrombotische strategieën bij AF na ACS/PCI

*geplaatst 2024-09-03 · Atriumfibrilleren · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2024.06.022 · https://hartvaat.nl/2024/09/03/augustus-4-weg-vergelijking-antitrombotische-strategieen-bij-af-na-acs-pci/*

Vierwegvergelijking van AUGUSTUS bevestigde dat apixaban plus P2Y12-remmer (zonder aspirine) de optimale strategie is bij AF na ACS/PCI. Deze combinatie biedt de beste balans tussen trombosepreventie en bloedingsrisico.

## English: Antithrombotic Strategies in Atrial Fibrillation After ACS and/or PCI: A 4-Way Comparison From AUGUSTUS.

This comprehensive AUGUSTUS four-way comparison confirmed that apixaban plus a P2Y12 inhibitor (without aspirin) is the optimal antithrombotic strategy for AF patients after ACS and/or PCI, providing the definitive analysis of the 2×2 factorial design.

## Abstract (original, from the publication)

BACKGROUND: The optimal antithrombotic regimen for patients with atrial fibrillation (AF) who had an acute coronary syndrome (ACS) or have undergone percutaneous coronary intervention (PCI) is not known. OBJECTIVES: The authors sought to determine which antithrombotic regimen best balances safety and efficacy. METHODS: AUGUSTUS, a multicenter 2 × 2 factorial design randomized trial compared apixaban with vitamin K antagonist (VKA) and aspirin with placebo in patients with AF with recent ACS and/or PCI treated with a P2Y12 inhibitor. We conducted a 4-way analysis comparing safety and efficacy outcomes in the 4 randomized groups. The primary outcome was a composite of all-cause death, major or clinically relevant nonmajor bleeding, or hospitalization for cardiovascular causes over 6-month follow-up. Secondary outcomes included individual components of the primary endpoint. RESULTS: A total of 4,614 patients were enrolled. All patients were treated with a P2Y12 inhibitor. The primary endpoint occurred in 21.9% of patients randomized to apixaban plus placebo, 27.3% randomized to apixaban plus aspirin, 28.0% randomized to VKA plus placebo, and 33.3% randomized to VKA plus aspirin. Rates of major or clinically relevant nonmajor bleeding and hospitalization for cardiovascular causes were lower with apixaban and placebo compared with the other 3 antithrombotic strategies. There was no difference between the 4 randomized groups with respect to all-cause death. CONCLUSIONS: In patients with AF and a recent ACS and/or PCI, an antithrombotic regimen that included a P2Y12 inhibitor and apixaban without aspirin resulted in a lower incidence of the composite of death, bleeding, or cardiovascular hospitalization than regimens including VKA, aspirin, or both. (An Open-label, 2 x 2 Factorial, Randomized Controlled, Clinical Trial to Evaluate the Safety of Apixaban vs. Vitamin K Antagonist and Aspirin vs. Aspirin Placebo in Patients with Atrial Fibrillation and Acute Coronary Syndrome or Percutaneous Coronary Intervention; NCT02415400).

Auteurs: Otavio Berwanger, Daniel M Wojdyla, Alexander C Fanaroff, Andrzej Budaj, Christopher B Granger, Roxana Mehran, Ronald Aronson, Stephan Windecker, Shaun G Goodman, John H Alexander, Renato D Lopes

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2024.06.022. Bijgewerkt 2026-07-03T13:30:10Z. 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.