Anticoagulation plus either one or two antiplatelet agents may be associated with better safety outcomes in patients with non-valvular atrial fibrillation (AFib), according to the results of the PIONEER AF-PCI Trial presented Nov. 14 during AHA 2016 and simultaneously published in the New England Journal of Medicine.

In an open-label, multicenter, controlled, randomized trial, C. Michael Gibson, MD, FACC, et al., assessed the effectiveness of anticoagulation with rivaroxaban plus either one or two antiplatelet agents on 2,124 patients with non-valvular AFib who had undergone percutaneous coronary intervention (PCI) with stenting. One group received low-dose rivaroxaban plus a P2Y₁₂ inhibitor for 12 months, another received very-low-dose rivaroxaban plus dual antiplatelet therapy (DAPT) for one, six or 12 months, while the third group received standard therapy of a dose-adjusted vitamin K antagonist plus DAPT for one, six or 12 months. The primary outcome was clinically significant bleeding.

The results of the trial show that those who received either low-dose rivaroxaban plus a P2Y₁₂ inhibitor for 12 months or very-low-dose rivaroxaban plus dual antiplatelet therapy (DAPT) for one, six or 12 months had lower rates of significant bleeding compared with the standard therapy group. The three groups had similar rates of death from cardiovascular events, myocardial infarction, or stroke.

In a related editorial comment published in Circulation, Deepak L. Bhatt, MD, MPH, FACC, explains that "from the PIONEER data to date, there seem to be significant benefits from abandoning the strategy of full dose triple therapy, with no apparent downside."

Keywords: AHA16, American Heart Association, AHA Annual Scientific Sessions, Administration, Oral, Acute Coronary Syndrome, Anticoagulants, Atrial Fibrillation, Percutaneous Coronary Intervention, Research Design, Vitamin K

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