Highlights of ESC HF 2021 - Insights from Augustus Trial

Efficacy and Safety of Antithrombotic Strategies in Patients with Atrial Fibrillation and Recent ACS or PCI With and Without A History of Heart Failure: Insights From the AUGUSTUS Trial The Augustus trial was done in AF patients with recent ACS or PCI, and Apixaban on the background of P2Y12 without aspirin resulted in less bleeding, few hospitalization,s and no significant difference in ischemic events compared to a regimen that included a Vitamin K Antagonist, aspirin or both. Heart Failure is frequent in this population due to a prothrombotic state and is associated with high mortality and morbidity. In this study, they evaluated the safety and efficacy of 2 different antithrombotic regimens in patients with or without Heart Failure irrespective of ejection fraction. 4614 patients with background P2Y12 therapy were randomized to either Apixaban or VKA regimen and each group was re-randomized to aspirin or placebo. At end of 6 months, the results showed that the patient group with Heart Failure had higher Cardiovascular death and All-cause death events compared to the group without Heart Failure, while the risk of major bleeding, all-cause death or hospitalization, or all-cause death or ischemic event remained fairly same between the group. Comparison between Apixaban and VKA therapy in patients with HF showed no significant difference in terms of major bleeding, all-cause mortality or hospitalization, or all-cause death or ischemic event. Similarly, Aspirin therapy in patients with Heart failure increases major bleeding events but remained statistically non-significant like the rest of the adverse events. Thus the study concluded that a history of Heart Failure is common in patients with AF and in recent ACS or PCI and also associated with an increased risk for all-cause and CV mortality. Irrespective of history of HF, treatment with P2Y12 and an antithrombotic regimen that included apixaban without aspirin resulted in less major or clinically relevant non-major bleeding and fewer death and hospitalizations than regimen that included a vitamin K antagonist, aspirin, or both. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.