TY - JOUR
T1 - Rivaroxaban Monotherapy in Patients With Atrial Fibrillation After Coronary Stenting
T2 - Insights From the AFIRE Trial
AU - AFIRE Investigators
AU - Matoba, Tetsuya
AU - Yasuda, Satoshi
AU - Kaikita, Koichi
AU - Akao, Masaharu
AU - Ako, Junya
AU - Nakamura, Masato
AU - Miyauchi, Katsumi
AU - Hagiwara, Nobuhisa
AU - Kimura, Kazuo
AU - Hirayama, Atsushi
AU - Matsui, Kunihiko
AU - Ogawa, Hisao
AU - Koretsune, Yukihiro
AU - Hiro, Takafumi
AU - Sumiyoshi, Tetsuya
AU - Kimura, Kazumi
AU - Hashimoto, Yoichiro
AU - Hirano, Teruyuki
AU - Daida, Hiroyuki
AU - Okada, Yasushi
AU - Yamazaki, Tsutomu
AU - Nakamura, A.
AU - Tamiya, E.
AU - Yamamoto, T.
AU - Suetake, S.
AU - Noguchi, T.
AU - Nakamura, S.
AU - Matsumura, A.
AU - Kojima, J.
AU - Suwa, S.
AU - Yamaguchi, H.
AU - Kaikita, K.
AU - Yasu, T.
AU - Nakajima, A.
AU - Yamada, T.
AU - Arai, H.
AU - Hata, Y.
AU - Sakanashi, T.
AU - Tateishi, H.
AU - Nakayama, T.
AU - Nozaki, Y.
AU - Akao, M.
AU - Okumura, Y.
AU - Tokue, M.
AU - Kuroki, N.
AU - Maruyama, Y.
AU - Matoba, T.
AU - Hagiwara, N.
AU - Suzuki, H.
AU - Ozaki, Y.
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/11/8
Y1 - 2021/11/8
N2 - Objectives: The aim of this AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial subgroup analysis was to examine rivaroxaban monotherapy benefits and their relation to the time between stenting and enrollment among patients after coronary stenting. Background: Of 2,215 patients with atrial fibrillation and stable coronary artery disease in the AFIRE trial, rivaroxaban monotherapy was noninferior to rivaroxaban plus antiplatelet therapy (combination therapy) in terms of efficacy and superior for safety endpoints. However, thrombotic risk after antiplatelet therapy cessation remained a concern among 1,444 patients who had undergone coronary stenting >1 year before enrollment. Methods: The benefits of rivaroxaban monotherapy in coronary stenting subgroups were assessed for efficacy (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death of any cause), safety (major bleeding defined according to International Society on Thrombosis and Haemostasis criteria), ischemic endpoints, net adverse clinical event, and time between stenting and enrollment. Results: Efficacy and safety endpoints for monotherapy were superior to combination therapy, with HRs of 0.70 for efficacy (95% CI: 0.50-0.98; P = 0.036) and 0.55 for safety (95% CI: 0.33-0.92; P = 0.019). For ischemic endpoints, the HR was 0.82 (95% CI: 0.58-1.15; P = 0.240). The HR became smaller with longer time between stenting and enrollment (efficacy, P for interaction = 0.158; safety, P = 0.097). Conclusions: In patients with atrial fibrillation after coronary stenting, the benefits of rivaroxaban monotherapy for efficacy and safety endpoints were consistent with those in the whole AFIRE trial population. The benefits became apparent with longer time between stenting and enrollment.
AB - Objectives: The aim of this AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial subgroup analysis was to examine rivaroxaban monotherapy benefits and their relation to the time between stenting and enrollment among patients after coronary stenting. Background: Of 2,215 patients with atrial fibrillation and stable coronary artery disease in the AFIRE trial, rivaroxaban monotherapy was noninferior to rivaroxaban plus antiplatelet therapy (combination therapy) in terms of efficacy and superior for safety endpoints. However, thrombotic risk after antiplatelet therapy cessation remained a concern among 1,444 patients who had undergone coronary stenting >1 year before enrollment. Methods: The benefits of rivaroxaban monotherapy in coronary stenting subgroups were assessed for efficacy (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death of any cause), safety (major bleeding defined according to International Society on Thrombosis and Haemostasis criteria), ischemic endpoints, net adverse clinical event, and time between stenting and enrollment. Results: Efficacy and safety endpoints for monotherapy were superior to combination therapy, with HRs of 0.70 for efficacy (95% CI: 0.50-0.98; P = 0.036) and 0.55 for safety (95% CI: 0.33-0.92; P = 0.019). For ischemic endpoints, the HR was 0.82 (95% CI: 0.58-1.15; P = 0.240). The HR became smaller with longer time between stenting and enrollment (efficacy, P for interaction = 0.158; safety, P = 0.097). Conclusions: In patients with atrial fibrillation after coronary stenting, the benefits of rivaroxaban monotherapy for efficacy and safety endpoints were consistent with those in the whole AFIRE trial population. The benefits became apparent with longer time between stenting and enrollment.
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U2 - 10.1016/j.jcin.2021.07.045
DO - 10.1016/j.jcin.2021.07.045
M3 - Article
C2 - 34736731
AN - SCOPUS:85117709274
SN - 1936-8798
VL - 14
SP - 2330
EP - 2340
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 21
ER -