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Anticoagulation Therapy for Stroke Prevention

Professor Renato Lopes

Read time: 15 mins
Last updated:24th Nov 2021
Published:24th Nov 2021

Meet cardiologist Professor Renato Lopes and learn more about the ground breaking AUGUSTUS trial in patients with atrial fibrillation with ACS and/or PCI in these video interviews.

Professor Renato Lopes

Professor Lopes is a cardiologist from Duke University with involvement in several clinical trials and large patient registries.

 

What unmet needs still need to be addressed in AF, particularly surrounding anticoagulation therapy and stroke prevention?

Professor Lopes describes the gaps that still exist as new therapies have not been thoroughly tested in all patients and clinical conditions. Learn about the areas where we still have gaps to close.

What made the AUGUSTUS trial such a game-changer and why was it needed?

Professor Lopes describes the 2x2 factorial design which involved 4,600 patients with atrial fibrillation and ACS with or without PCI and independently assessed the contribution on bleeding and on ischaemic events reduction in bleeding with apixaban and warfarin.

 

Does this mean that antithrombotic strategies are better without aspirin? Is less really more?

Professor Lopes describes how the recent meta-analysis has shown that classic triple therapy with aspirin, a P2Y inhibitor and warfarin should be avoided as these drug combinations have the worst bleeding outcomes.

 

What was the ENTRUST study and how does this provide context to the AUGUSTUS trial?

Professor Lopes summarises the ENTRUST-AF study comparing edoxaban in a double therapy with a P2Y12 inhibitor vs. warfarin as part of a triple therapy which has been important in adding to the body of knowledge in this field.

 

What further insights have the incorporation of AUGUSTUS data to recent meta-analysis given us?

Professor Lopes describes the collective and individual input of the AUGUSTUS trial in the recent meta-analysis.

How will this help provide a more robust and tailored prescription in high risk patients?

Professor Lopes gives his opinion on when to use and stop aspirin following  hospitalisation for treatment of atrial fibrillation with ACS and /or PCI.

 

Is double therapy really the best option for all patients with AF and recent ACS or PCI?

Professor Lopes describes how research is ongoing to determine the specific patient populations for which aspirin is still suitable for in addition to the preferred double therapy strategy.

 

In the future will there still be a need for triple therapy?

Find out how the results of the AUGUSTUS study have influenced the treatment choice should triple therapy be required. Generally a DOAC should be used and not warfarin in triple therapy and only for short periods of time.

What's the future outlook of anticoagulation management in AF?

Professor Lopes describes the tremendous progress over the past 10 years in patients with atrial fibrillation and key subgroups. Filling the remaining gaps is a priority for the future and the hope is to further refine DOAC treatment.

Is there anything else that we need to be aware of when using NOACs as a treatment?

Professor Lopes describes how the balance between reducing ischaemic events and the cost of bleeding drives decisions in clinical practice.

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