{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:55:44Z","timestamp":1755795344407,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T00:00:00Z","timestamp":1644969600000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002491","name":"Bristol-Myers Squibb","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002491","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2022,1,11]]},"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Managing antithrombotic therapy in patients with atrial fibrillation (AF) and an acute coronary syndrome (ACS) and\/or percutaneous coronary intervention (PCI) is challenging and can be affected by prior oral anticoagulant (OAC) treatment. We examined the relationship between prior OAC use and outcomes in the AUGUSTUS trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This prespecified secondary analysis is from AUGUSTUS, an open-label, 2-by-2 factorial, RCT to evaluate the safety of apixaban versus vitamin K antagonist (VKA) and aspirin versus placebo in patients with AF and ACS and\/or PCI. The primary endpoint, major or clinically relevant non-major bleeding and clinical outcomes were compared in patients receiving (n=2262) or not receiving (n=2352) an OAC prior to enrolment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Patients with prior OAC use had more comorbidities, higher CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASC and HAS-BLED scores, and were more likely enrolled following elective PCI. There was no difference in major or clinically relevant non-major bleeding with or without prior OAC (30 days: 5.1% vs 5.9% (adjusted HR (aHR) 0.82, 95%\u2009CI 0.63 to 1.06); 180 days: 13.5% vs 13.5% (aHR 0.98, 95% CI 0.83 to 1.16)). Patients with prior OAC use had a lower risk of death or ischaemic events (30 days: 1.7% vs 2.8% (aHR 0.61, 95% CI 0.41 to 0.92); 180 days: 5.4% vs 7.6% (aHR 0.70, 95% CI 0.55 to 0.88)). No interactions between randomised treatment (apixaban vs VKA, aspirin vs placebo) and prior OAC status were observed for outcomes, apart from apixaban (vs VKA) being associated with a lower risk of myocardial infarction with prior OAC use (180 days: 2.0% vs 3.7% (aHR 0.56, 95% CI 0.33 to 0.91().<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In AUGUSTUS, prior OAC use was associated with fewer ischaemic events but not more bleeding. In patients with AF and ACS and\/or undergoing PCI, clinicians can be assured that the trial results can be applied to patients regardless of their prior OAC status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02415400\">NCT02415400<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2021-001892","type":"journal-article","created":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T11:16:30Z","timestamp":1645010190000},"page":"e001892","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of prior oral anticoagulant use and outcomes on patients from secondary analysis in the AUGUSTUS trial"],"prefix":"10.1136","volume":"9","clinical-trial-number":[{"clinical-trial-number":"nct02415400","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2613-9142","authenticated-orcid":false,"given":"Robert C.","family":"Welsh","sequence":"first","affiliation":[{"name":"Cardiac Sciences, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Payam","family":"Dehghani","sequence":"additional","affiliation":[{"name":"Medicine, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renato","family":"Lopes","sequence":"additional","affiliation":[{"name":"Cardiology, Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel M","family":"Wojdyla","sequence":"additional","affiliation":[{"name":"Cardiology, Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald","family":"Aronson","sequence":"additional","affiliation":[{"name":"Bristol-Myers Squibb Co, Princeton, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher B","family":"Granger","sequence":"additional","affiliation":[{"name":"Cardiology, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Windecker","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Swiss Cardiovascular Center, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit N","family":"Vora","sequence":"additional","affiliation":[{"name":"Cardiology, Pinnacle Heart and Vascular Institue, Harrisburg, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dragos","family":"Vinereanu","sequence":"additional","affiliation":[{"name":"Cardiology, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sigrun","family":"Halvorsen","sequence":"additional","affiliation":[{"name":"Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Parkhomenko","sequence":"additional","affiliation":[{"name":"Cardiology, National Scientific Center Academician M D Strazhesko Institute of Cardiology of the National Academy of Medical Sciences of Ukraine, Kiiv, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxana","family":"Mehran","sequence":"additional","affiliation":[{"name":"Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John H","family":"Alexander","sequence":"additional","affiliation":[{"name":"Cardiology, Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaun","family":"Goodman","sequence":"additional","affiliation":[{"name":"Canadian Heart Research Centre, Toronto, Ontario, Canada"},{"name":"Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,2,16]]},"reference":[{"key":"2025081710225802000_9.1.e001892.1","doi-asserted-by":"publisher","DOI":"10.1160\/TH10-05-0332"},{"key":"2025081710225802000_9.1.e001892.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.06.029"},{"key":"2025081710225802000_9.1.e001892.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.11.030"},{"key":"2025081710225802000_9.1.e001892.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1708454"},{"key":"2025081710225802000_9.1.e001892.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611594"},{"key":"2025081710225802000_9.1.e001892.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1817083"},{"key":"2025081710225802000_9.1.e001892.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31872-0"},{"key":"2025081710225802000_9.1.e001892.8","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz732"},{"key":"2025081710225802000_9.1.e001892.9","doi-asserted-by":"crossref","first-page":"381","DOI":"10.4244\/EIJY14M06_07","article-title":"Uninterrupted oral anticoagulation versus bridging in patients with long-term oral anticoagulation during percutaneous coronary intervention: subgroup analysis from the WOEST trial","volume":"11","author":"Dewilde","year":"2015","journal-title":"EuroIntervention"},{"key":"2025081710225802000_9.1.e001892.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2014.09.006"},{"key":"2025081710225802000_9.1.e001892.11","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-11-1206"},{"key":"2025081710225802000_9.1.e001892.12","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000132"},{"key":"2025081710225802000_9.1.e001892.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.05.028"},{"key":"2025081710225802000_9.1.e001892.14","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ahj.2018.03.001","article-title":"An open-label, 2 \u00d7 2 factorial, randomized controlled trial to evaluate the safety of apixaban vs. vitamin K antagonist and aspirin vs. placebo in patients with atrial fibrillation and acute coronary syndrome and\/or percutaneous coronary intervention: rationale and design of the AUGUSTUS trial","volume":"200","author":"Lopes","year":"2018","journal-title":"Am Heart J"},{"key":"2025081710225802000_9.1.e001892.15","doi-asserted-by":"crossref","first-page":"e150","DOI":"10.1016\/S2352-3026(15)00027-7","article-title":"Risk of bleeding and arterial thromboembolism in patients with non-valvular atrial fibrillation either maintained on a vitamin K antagonist or switched to a non-vitamin K-antagonist oral anticoagulant: a retrospective, matched-cohort study","volume":"2","author":"Bouillon","year":"2015","journal-title":"Lancet Haematol"},{"key":"2025081710225802000_9.1.e001892.16","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-12-201306180-00003"},{"key":"2025081710225802000_9.1.e001892.17","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.015710"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2021-001892","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:23:10Z","timestamp":1755451390000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2021-001892"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,2,16]]},"published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1136\/openhrt-2021-001892"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2021-001892","relation":{},"ISSN":["2053-3624"],"issn-type":[{"type":"electronic","value":"2053-3624"}],"subject":[],"published":{"date-parts":[[2022,2]]}}}