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Anticoagulation Therapy for Stroke Prevention

Professor Robert Storey

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

Hear Professor Storey’s opinion on the changing treatment landscape for stroke prevention in patients with atrial fibrillation and ACS and/or PCI.

 

Featured interview with Professor Robert Storey

In your opinion why was the AUGUSTUS trial such a game changer?

Professor Storey describes how the AUGUSTUS trial answered two very distinct questions:

- is a NOAC such as apixaban at its licensed dose for atrial fibrillation superior in terms of safety efficacy balance compared to a vitamin K antagonist such as warfarin?

- what is the risk and/or benefit of having aspirin in the combination of antithrombotic drugs?

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Professor Rob Storey

Rob Storey is a Professor of Cardiology at the University of Sheffield in the UK who has worked on a number of the ESC Guidelines including the most recent 2019 acute coronary syndrome guidelines.

 

What unmet need still exists and how is the landscape evolving for patients with atrial fibrillation and ACS undergoing PCI?

Professor Storey describes the need to deal with bleeding risk while effectively preventing thrombotic events in patients with cardioembolic thrombotic events and coronary thrombotic events.

 

How do you think this unmet need could be overcome?

Learn why we need more evidence to determine optimal antithrombotic therapy to reducing the number of bleeding events while still preventing important thrombotic events.

 

How do you feel the landscape is evolving for patients with atrial fibrillation and ACS and/or PCI?

Professor Storey describes the earlier gaps in evidence due to low power studies which have now been addressed by the AUGUSTUS study.

 

What is the best regimen of antithrombotic therapy for AF patients with ACS and/or PCI?

Professor Storey describes how the AUGUSTUS study data has given insights into dual therapy with anticoagulant and P2Y12 antagonist vs. triple therapy with aspirin, P2Y12 inhibitor and an oral anticoagulant and how best to individualise therapy according to the risks of stroke and stent thrombosis.

Do you think the AUGUSTUS results will change cardiologist prescribing habits?

Professor Storey describes that AUGUSTUS data highlighted the benefit of dropping aspirin to reduce bleeding events and how to use risk of stent thrombosis to guide the decision of when to drop aspirin and just use dual therapy with a DOAC such as apixaban. 

 

In your opinion why was the AUGUSTUS trial such a game changer?

Professor Storey describes how the AUGUSTUS trial answered two very distinct questions:

- is a NOAC such as apixaban at its licensed dose for atrial fibrillation superior in terms of safety efficacy balance compared to a vitamin K antagonist such as warfarin?

- what is the risk and/or benefit of having aspirin in the combination of antithrombotic drugs?

What's the future of anticoagulation management in atrial fibrillation?

While a move towards more reliable P2Y12 inhibitors used in combination with a DOAC is likely in the complex setting of PCI, Professor Storey also invites caution. Find out why.

 

Why do you feel cardiologists are distrustful of real-world evidence?

Learn about the factors that lead to confounding in real world data and why we should be cautious interpreting the data and use it to generate hypotheses for further investigation.

 

What can be done to challenge the perception that real world data is of less value than RCTs in decision making?

Find out how Professor Storey thinks that real-world evidence studies can be improved.

 

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