Acute Coronary Syndrome Benefits From Both Antiplatelets and DOACs

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Patients with STEMI had a pronounced benefit from therapy with both antiplatelet drugs and DOACs.
Patients with STEMI had a pronounced benefit from therapy with both antiplatelet drugs and DOACs.

HealthDay News — For patients with acute coronary syndrome (ACS), treatment with direct oral anticoagulants (DOACs) in addition to antiplatelet therapy (APT) appears efficacious for those with ST-segment elevation myocardial infarction (STEMI), according to a review published in JAMA Cardiology.

Mauro Chiarito, MD, from Humanitas University in Milan, and colleagues examined the safety and efficacy of DOACs in addition to APT after ACS using data from 6 trials with 29,667 patients (14,580 patients with STEMI and 15,036 with non-ST-segment elevation ACS [NSTE-ACS]).

The researchers found that the risk for the primary efficacy end point (composite of cardiovascular death, myocardial infarction, and stroke) was significantly lower for patients treated with DOAC vs APT alone (odds ratio, 0.85; 95% CI, 0.77-0.93; P <.001). 

Patients with STEMI had a pronounced benefit (odds ratio, 0.76; 95% CI, 0.66-0.88; P <.001) whereas patients with NSTE-ACS had no significant treatment effect (odds ratio, 0.92; 95% CI, 0.78-1.09; P =.36; P for interaction =.09). Compared with APT alone, DOACs were correlated with significantly increased risk for major bleeding, with consistent results for patients with STEMI and NSTE-ACS.

"To our knowledge, these findings are the first evidence to support differential treatment effects of DOACs in addition to APT according to ACS baseline clinical presentation," the authors wrote.

Disclosures: Several authors disclosed financial ties to the pharmaceutical and medical device industries.

Reference

Chiarito M, Cao D, Cannata F, et al. Direct oral anticoagulants in addition to antiplatelet therapy for secondary prevention after acute coronary syndromes [published online February 7, 2018]. JAMA Cardiol. doi:10.1001/jamacardio.2017.5306

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