TABLE 1.
WOEST | PIONEER AF-PCI | RE-DUAL PCI | AUGUSTUS | ENTRUST-AF PCI | |
NCT00769938 | NCT01830543 | NCT02164864 | NCT02415400 | NCT02866175 | |
Follow-up | 12 months | 12 months | 14 months | 6 months | 12 months |
Sample size | 573 | 2,124 | 2,725 | 4,614 | 1,506 |
Enrollment | November 2008 to November 2011 | May 2013 to July 2015 | July 2014 to October 2016 | September 2015 to April 2018 | February 2017 to May 2018 |
Design | Open-label, randomized, controlled trial at 15 sites in the Netherlands and Belgium | International, multicenter, randomized, open-label trial at 431 sites | International, multicenter, randomized, open-label trial at 414 sites in 41 countries | Prospective, multicenter, two-by-two factorial, randomized clinical trial at 492 sites in 33 countries | Randomized, multicenter, open-label, non-inferiority phase 3b trial at 186 sites in 18 countries |
Intervention | Double therapy: OAC and clopidogrel Triple therapy: aspirin, OAC, and clopidogrel | Group 1: low-dose rivaroxaban (15 mg once daily) plus a P2Y12 inhibitor for 12 months Group 2: very-low-dose rivaroxaban (2.5 mg twice daily) plus DAPT for 1, 6, or 12 months Group 3: VKA plus DAPT for 1, 6, or 12 months | Dual therapy: dabigatran (110 or 150 mg twice daily) plus a P2Y12 inhibitor (clopidogrel or ticagrelor) Triple therapy: warfarin plus DAPT (for 1–3 months) | Dual therapy: apixaban (5 mg twice daily) or VKA and a P2Y12 inhibitor for 6 months Triple therapy: apixaban or VKA and DAPT for 6 months | Dual therapy: edoxaban (60 mg once daily) plus a P2Y12 inhibitor for 12 months Triple therapy: VKA and DAPT |
Inclusion criteria | A long-term indication for oral anticoagulation treatment (until at least 1 year after the study); a severe coronary lesion with indication for PCI; and age 18–80 years | Documented atrial fibrillation that occurred within 1 year before screening; patients with documented atrial fibrillation that occurred more than 1 year before screening were also eligible if the participant had been receiving oral anticoagulation for atrial fibrillation for the 3 months immediately preceding the index PCI | Men and women who were at least 18 years of age were eligible for inclusion in the trial if they had non-valvular atrial fibrillation and had successfully undergone PCI with a bare-metal or drug-eluting stent within the previous 120 h. Non-valvular atrial fibrillation could be paroxysmal, persistent, or permanent, but it could not be secondary to a reversible disorder unless long-term treatment with an oral anticoagulant was anticipated. Patients who had been receiving treatment with an oral anticoagulant before PCI and those who had not received oral anticoagulation were eligible | An age of at least 18 years; previous, persistent, permanent, or paroxysmal atrial fibrillation and planned long-term use of an oral anticoagulant; recent acute coronary syndrome or PCI; and planned use of a P2Y12 inhibitor for at least 6 months | Aged at least 18 years, and had a successful PCI for stable coronary artery disease or acute coronary syndrome |
Exclusion criteria | A history of intracranial bleeding; cardiogenic shock; contra indication to use of aspirin, clopidogrel, or both; peptic ulcer in the previous 6 months; thrombocytopenia; major bleeding in the past 12 months; and pregnancy | A history of stroke or transient ischemic attack, clinically significant gastrointestinal bleeding within 12 months before randomization, a calculated creatinine clearance of less than 30 ml per minute, anemia of an unknown cause with a hemoglobin concentration of less than 10 g per deciliter, or any other condition known to increase the risk of bleeding | The presence of bioprosthetic or mechanical heart valves, severe renal insufficiency, or other major coexisting conditions | Patients who were using anticoagulation for other conditions were not eligible. Other key exclusion criteria were severe renal insufficiency, a history of intracranial hemorrhage, recent or planned coronary-artery bypass graft surgery, coagulopathy or ongoing bleeding, and contraindication to a VKA, apixaban, all P2Y12 inhibitors, or aspirin | Patients with non-valvular atrial fibrillation not secondary to a reversible disorder were included and patients with mechanical heart valves, moderate-to-severe mitral stenosis, end-stage renal disease, and other major comorbidities were excluded |
Outcomes | The primary endpoint was the occurrence of any bleeding episode during 1-year follow-up. The composite secondary endpoint of death, myocardial infarction, stroke, target-vessel revascularization, and stent thrombosis | The primary safety end point was the occurrence of clinically significant bleeding. Secondary end points included the incidence of each component of the primary safety end point, as well as the following efficacy end points: the occurrence of a major adverse cardiovascular event, each component of the major adverse cardiovascular event end point, and stent thrombosis | The primary end point was a major or clinically relevant non-major bleeding event. A main secondary end point was a composite efficacy end point of thromboembolic events, death, or unplanned revascularization. Other secondary end points included a combined end point of thromboembolic events or death, as well as the individual thromboembolic events and definite stent thrombosis | The primary outcome was major or clinically relevant non-major bleeding. Secondary outcomes included death or hospitalization and a composite of ischemic events | The primary endpoint was a composite of major or clinically relevant non-major bleeding. The main efficacy outcome was the composite of cardiovascular death, stroke, systemic embolic events, myocardial infarction, and definite stent thrombosis |
VKA, vitamin K antagonist (warfarin or phenprocoumon, a target international normalization ratio of 2.0–3.0); DAPT, dual antiplatelet therapy (aspirin a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel).