Omission of aspirin after ACS or stenting in patients with oral anticoagulation – why have the goalposts moved?


Antithrombotic drugs are used to prevent ischaemic complications in patients with coronary artery disease and/or atrial fibrillation. Randomised trials showed that, after coronary stenting, dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor was superior to aspirin and oral anticoagulation in preventing ischaemic events, with a reduced or comparable risk of bleeding. Similarly, in the case of patients with atrial fibrillation, oral anticoagulation with a vitamin K antagonist (VKA) is superior to DAPT in preventing ischaemic events, albeit at the cost of increased bleeding. As a rule of thumb, such trials have evaluated new antithrombotic drugs or regimens based on primary endpoints indicating efficacy, with safety representing a co-primary or secondary endpoint.

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Byrne RA, Colleran R, Kastrati A. EuroIntervention 2019;14:e1793–5.