RT Journal Article SR Electronic T1 Aspirin versus P2Y12 inhibitors with anticoagulation therapy for atrial fibrillation JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 1731 OP 1738 DO 10.1136/heartjnl-2021-319321 VO 107 IS 21 A1 Hidehira Fukaya A1 Junya Ako A1 Satoshi Yasuda A1 Koichi Kaikita A1 Masaharu Akao A1 Tetsuya Matoba A1 Masato Nakamra A1 Katsumi Miyauchi A1 Nobuhisa Hagiwara A1 Kazuo Kimura A1 Atsushi Hirayama A1 Kunihiko Matsui A1 Hisao Ogawa YR 2021 UL http://heart.bmj.com/content/107/21/1731.abstract AB Objective Patients with coronary artery disease (CAD) and atrial fibrillation (AF) can be treated with multiple antithrombotic therapies including antiplatelet and anticoagulant therapies; however, this has the potential to increase bleeding risk. Here, we aimed to evaluate the efficacy and safety of P2Y12 inhibitors and aspirin in patients also receiving anticoagulant therapy.Methods We evaluated patients from the Atrial Fibrillation and Ischaemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial who received rivaroxaban plus an antiplatelet agent; the choice of antiplatelet agent was left to the physician’s discretion. The primary efficacy and safety end points, consistent with those of the AFIRE trial, were compared between P2Y12 inhibitors and aspirin groups. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularisation or death from any cause. The primary safety end point was major bleeding according to the International Society on Thrombosis and Haemostasis criteria.Results A total of 1075 patients were included (P2Y12 inhibitor group, n=297; aspirin group, n=778). Approximately 60% of patients were administered proton pump inhibitors (PPIs) and there was no significant difference in PPI use in the groups. There were no significant differences in the primary end points between the groups (efficacy: HR 1.31; 95% CI 0.88 to 1.94; p=0.178; safety: HR 0.79; 95% CI 0.43 to 1.47; p=0.456).Conclusions There were no significant differences in cardiovascular and bleeding events in patients with AF and stable CAD taking rivaroxaban with P2Y12 inhibitors or aspirin in the chronic phase.Trial registration number UMIN000016612; NCT02642419.Data are available on reasonable request.