Low-dose NOAC linked to lower bleeding rates vs triple therapy in patients with Afib having PCI

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Takeaway 

  • Patients with atrial fibrillation (Afib) having percutaneous coronary intervention have less clinically significant bleeding with low- or very-low-dose rivaroxaban combination therapies vs triple therapy with vitamin K antagonist.

Why this matters  

  • Usual therapy is vitamin K antagonist+dual antiplatelet therapy (DAPT: P2Y12 inhibitor and aspirin), but relative efficacy and safety of rivaroxaban, a novel oral anticoagulant, are unclear.

Key results 

  • Rivaroxaban groups had significantly less bleeding vs standard triple-therapy groups (16.8%, 18.0% vs 26.7% with triple therapy; HRs with rivaroxaban 0.59, 0.63; P<.001 for both comparisons).
  • Outcomes were similar among the 3 treatment groups for cardiovascular, myocardial infarction, and stroke deaths.
  • 21.0% of low-dose rivaroxaban, 21.1% very-low-dose rivaroxaban, 29.4% triple-ther...