Patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) will benefit from rivaroxaban monotherapy both in terms of safety and efficacy.
The AFIRE study included 2215 patients with atrial fibrillation and stable coronary artery disease (CAD). A subgroups analysis recently published in JACC Intv evaluated patients undergoing coronary stenting.
The study compared rivaroxaban + antiplatelet therapy (combined therapy) vs rivaroxaban monotherapy.
In the general population, rivaroxaban resulted non-inferior to the combined therapy in terms of efficacy and was superior when it came to safety. However, 1444 patients undergoing coronary stenting presented thrombotic events when stopping the antiplatelet therapy.
On the one hand this subgroups study looked at an efficacy combined end point (stroke, systemic embolism, MI, unstable angina requiring revascularization and all cause death) and on the other hand, major bleeding.
Rivaroxaban monotherapy resulted superior in both safety and efficacy vs. the combined therapy (HR 0.7; p= 0.036 for efficacy and HR 0.55; p=0.019 for safety).
Read also: Is Troponin Elevation After TAVR Related to Mortality?
The longer the time between stenting and enrollment, the greater the benefit.
Conclusion
In patients with atrial fibrillation undergoing coronary angioplasty, rivaroxaban monotherapy resulted superior in safety and efficacy vs. the combined therapy. (rivaroxaban + antiplatelet antiaggregation)
Original Title: Rivaroxaban Monotherapy in Patients With Atrial Fibrillation After Coronary Stenting: Insights From the AFIRE Trial.
Reference: Tetsuya Matoba et al. J Am Coll Cardiol Intv. 2021 Nov, 14 (21) 2330–2340.
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