Atrial fibrillation and ischemic events with rivaroxaban in patients with stable coronary artery disease (AFIRE): Protocol for a multicenter, prospective, randomized, open-label, parallel group study

作者：Yasuda Satoshi^*; Kaikita Koichi; Ogawa Hisao; Akao Masaharu; Ako Junya; Matoba Tetsuya; Nakamura Masato; Miyauchi Katsumi; Hagiwara Nobuhisa; Kimura Kazuo; Hirayama Atsushi; Matsui Kunihiko

来源：International Journal of Cardiology, 2018, 265: 108-112.

DOI：10.1016/j.ijcard.2018.04.131

• Atrial fibrillation
• Anticoagulants
• Rivaroxaban
• Bleeding
• Trial protocol

Background: In atrial fibrillation (AF) patients with coronary artery disease (CAD), anticoagulants are commonly used in combination with antiplatelet drugs. However, dual therapy can increase the risk of bleeding, and the potential therapeutic benefits must be weighed against this. Therefore, it is recommended that dual therapy is only used for a limited time, and that monotherapy with anticoagulants should start from 1 year after percutaneous coronary intervention (PCI). However, there is a lack of evidence on the use of monotherapy, in particular with direct oral anticoagulants, in this group of patients.
Methods: The AFIRE Study is a multicenter, prospective, randomized, open-label, parallel group study conducted in patients aged >= 20 years with non-valvular AF (NVAF) and CAD. Patients who have undergone PCI or coronary artery bypass graft at least 1 year prior to enrollment, or those without significant coronary lesions requiring PCI (>= 50% stenosis), will be included. Approximately 2200 participants will be randomized to receive either rivaroxaban monotherapy or rivaroxaban plus an antiplatelet drug (aspirin, clopidogrel, or prasugrel). The primary efficacy end-points are the composite of cardiovascular events (stroke, non-central nervous system embolism, myocardial infarction, and unstable angina pectoris requiring revascularizations) and all-cause mortality. The primary safety endpoint is major bleeding as defined by the International Society on Thrombosis and Haemostasis criteria.
Conclusions: This study will be the first to assess the efficacy and safety of rivaroxaban monotherapy in NVAF patients with stable CAD.

• 出版日期2018-8-15