Atrial fibrillation and ischemic events with rivaroxaban in patients with stable coronary artery disease (AFIRE): Protocol for a multicenter, prospective, randomized, open-label, parallel group study.

Abstract

BACKGROUND:

In atrial fibrillation (AF) patients with coronary artery disease (CAD), anticoagulants are commonly used in combination with antiplatelet drugs. However, dual therapy can increase the risk of bleeding, and the potential therapeutic benefits must be weighed against this. Therefore, it is recommended that dual therapy is only used for a limited time, and that monotherapy with anticoagulants should start from 1 year after percutaneous coronary intervention (PCI). However, there is a lack of evidence on the use of monotherapy, in particular with direct oral anticoagulants, in this group of patients.

METHODS:

The AFIRE Study is a multicenter, prospective, randomized, open-label, parallel group study conducted in patients aged ≥20 years with non-valvular AF (NVAF) and CAD. Patients who have undergone PCI or coronary artery bypass graft at least 1 year prior to enrollment, or those without significant coronary lesions requiring PCI (≥50% stenosis), will be included. Approximately 2200 participants will be randomized to receive either rivaroxaban monotherapy or rivaroxaban plus an antiplatelet drug (aspirin, clopidogrel, or prasugrel). The primary efficacy endpoints are the composite of cardiovascular events (stroke, non-central nervous system embolism, myocardial infarction, and unstable angina pectoris requiring revascularizations) and all-cause mortality. The primary safety endpoint is major bleeding as defined by the International Society on Thrombosis and Haemostasis criteria.

CONCLUSIONS:

This study will be the first to assess the efficacy and safety of rivaroxaban monotherapy in NVAF patients with stable CAD.

• Authors: Satoshi Yasuda, Koichi Kaikita, Hisao Ogawa, Masaharu Akao, Junya Ako, Tetsuya Matoba, Masato Nakamura, Katsumi Miyauchi, Nobuhisa Hagiwara, Kazuo Kimura, Atsushi Hirayama, Kunihiko Matsui
• Journal: International journal of cardiology (Int J Cardiol) Vol. 265 Pg. 108-112 (Aug 15 2018) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 29764706 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2018. Published by Elsevier B.V.

Chemical References

• Factor Xa Inhibitors
• Platelet Aggregation Inhibitors
• Rivaroxaban

Topics

• Atrial Fibrillation (blood, diagnosis, drug therapy)
• Coronary Artery Disease (blood, diagnosis, drug therapy)
• Drug Therapy, Combination
• Factor Xa Inhibitors (administration & dosage, blood)
• Female
• Hemorrhage (chemically induced, diagnosis)
• Humans
• Male
• Myocardial Ischemia (blood, diagnosis, drug therapy)
• Platelet Aggregation Inhibitors (administration & dosage, blood)
• Prospective Studies
• Rivaroxaban (administration & dosage, adverse effects, blood)