March 24, 2023

Dr. Peter Block interviews presenter Dr. Renato Lopes regarding AUGUSTUS:, apixaban vs. vitamin K antagonist and aspirin vs. placebo in AFib and ACS, PCI. Visit for full meeting coverage.

I’m peter block at acc 2019 in new orleans with me on my left is for natalie lopez from duke and he has done the augustus trial now the augustus trial i hate to say it but it is a game changer for the way we take care of clinical patients and i’m not going to take away any wind out of his sails so tell me what this trial was for natto and then we’ll talk about what

It really means sure peter so the august’s – i really tried to answer two questions in a population that is a high-risk group which is patients with atrial fibrillation and a recent acute coronary syndrome or pci and basically we had to answer is a pixum and safer than vka in patients that are already taking a pitch y12 enabler so the p2i traveling where was the

Background therapy okay so everybody gets clopidogrel color brown or or any other people but it was clopidogrel in ninety-three percent of the patients so basically clopidogrel was the main pitch while traveling of choice and then we first randomized patients to a pixie ban or vka so that was the first part of the trial but because was a 2 by 2 factorial design we

Also have a second randomization factor which was a spring versus placebo and the idea behind that was to try to assess also how important sp is or is not in the regiments when treating these patients in terms of a traumatic time how much a sprint you put them on for tomorrow anyway so not very much aspirin no those eyes okay so what you find we found that a pixel

Burn was much better for bleeding with a 31 percent reduction in bleeding and in hospitalizations compared to vka and no difference in skimming events and on the aspirin side we found that adding aspirin increased the risk of bleeding by 89% and we do not find any significant difference in hospitalizations and we do not find any significant difference in skimming

Events so those are the summary of the two comparisons that we did okay so another weave for the last i don’t know maybe five years have been discussing this issue of whether no acts would be good to a fibrillation particularly from my point of view as an interventional cardiologist after a stent what do i do with somebody in half so what are you gonna tell the

Folks out there we now need to change completely in terms of triple their triple therapies gone right i think you people therapy is going to be for a really reserved situation i think they will t now should the standard of care should be a nowak i think we have no questions anymore because even guidelines a few guidelines to have a preferred recommendation for

No acts instead of vka right so i think now we have confident using no acts in those patients and i think a novak plays a pitch white reliever might be enough for most patients we might not need aspirin in other words less might be more in this clinical setting okay and i would agree with you totally looking at the data the addition of aspirin i think the risk

Of bleeding sort of overcomes the benefits you get out of aspirin that’s right so for anyone that’s got patients with atrial fibrillation out there particularly after stunning and if they are an acs and they need something go with a no act go with a clitoral and you’re probably going to do enough for your patients i think i think that’s correct and of course if

As we might be needed we might be able to identify with further analysis but the important also message that if you wanna us asking for any reason no question that it should be on the with a no whack and always vkn there you go thank you very much for donna thank you you

Transcribed from video
AUGUSTUS | ACC.19 By American College of Cardiology