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Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease
Thursday | July 23, 2020| 12:00pm - 1:00pm ESTPresenter:
PresentersGeoff Barnes, MD, MSc• Assistant Professor of Medicine, Vascular and
Cardiovascular Medicine, University of Michigan
Tracy Minichiello, MD• Professor of Medicine, University of California, San
Francisco• Chief of Anticoagulation and Thrombosis Services,
San Francisco VA Medical Center
Arthur Allen, PharmD, CACP• Anticoagulation Program Manager, VA Salt Lake City
Health Care System
Diane Wirth, ANP, CACP• Adult Nurse Practitioner, Grady Memorial Hospital• Interim Executive Director of Cardiovascular Services
and Manager of the Heart Failure Program, Grady Memorial Hospital
Renato Lopes, MD• Professor of Medicine of the Department of Medicine
of the Division of Cardiology at Duke University Medical Center, Duke Clinical Research Institute
Dominick Angiolillo, MD• Professor of Medicine with tenure status, University of
Florida Health System• Director of Cardiovascular Research, University of
Florida Health System• Program Director of the Interventional Cardiology
Fellowship Program, University of Florida Health System
• Staff cardiologist and interventional cardiologist, University of Florida Health System
Roxana Mehran, MD• Professor of Medicine, Zena and Michael A. Wiener
Cardiovascular Institute at Mount Sinai School of Medicine
• Director of Interventional Cardiovascular Research and Clinical Trials, Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai School of Medicine
Background• Use of dual antiplatelet therapy (DAPT) after percutaneous coronary
Any Bleeding 146 (7.22) 238 (12.72) 0.58 (0.47-0.71)
AFIRE Conclusions• Rivaroxaban monotherapy non-inferior to riva + antiplatelet in AF +
stable CAD patients• Cardiovascular events• Death from any cause
• Rivaroxaban monotherapy superior to riva + antiplatelet• Major bleeding
Study Strengths• Important clinical question• Randomized methodology• Few patients lost screening randomization step• Large patient population• Robust outcome measures
Study Limitation• Rivaroxaban and prasugrel doses differ from US dosing
• Open-label design potential for reporting bias
• High “loss to follow up” (~12% of randomized population)
• Study terminated early potential for over-estimating efficacy
• Mechanism for lower ischemic events in rivaroxaban monotherapy group without pre-specified causal mechanism chance finding?
• No use of DAPT (or similar) score
Group Discussion• How should these two studies inform care of AF + CAD patients in North
America?• Different patients• Different medication doses• Early termination
• At what point does a CAD patient become “stable”?• How to integrate “CAD complexity” into decision-making?• How to choose between warfarin and DOAC for AF + CAD patients?• Who was NOT randomized? Who should NOT stop DAPT?• How to discuss findings with cardiology?• How might these findings apply to VTE patients?
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Our 2-day Boot Camp course will be broadcast virtually on September 25th & 26th. The cost is only $199 with 30-day extended access so registered attendees can view sessions at a later date or more than once and still earn 10.75 CME hours.
Gain access to this thorough curriculum with this unique opportunity for online learning.
Faculty: Arthur Allen, PharmD; Geoff Barnes, MD; Nathan Clark, PharmD; Scott Kaatz, DO & Diane Wirth, ANP
Join us for our next Webinar on COVID-19 and VTE: Breaking Down the Connection
Tuesday | August 4, 2020 | 7:00 - 8:00 PM ETin collaboration with
Hear about the most up to date information on COVID-19 from the Director of Global Infectious Diseases from Mass General Hospital, Dr. Edward Ryan and from Dr. Scott Kaatz, our AC Forum Board President, who personally experienced COVID-19 and PE.
Register Here!
Guest Speakers• Scott Kaatz, DO• Edward Ryan, MDModerator:• Rachel Rosovsky, MD