Thank you Nikita for leading us through a discussion of the AFIRE trial.

Clinical Question:

In patients with atrial fibrillation and stable CAD >1 year after revascularization (or confirmed CAD on angiography not requiring revascularization), how does rivaroxaban monotherapy compare to rivaroxaban plus an antiplatelet agent in terms of efficacy and safety?

Bottom Line:

In the long-term management of patients with stable CAD and afib, rivaroxaban alone is not only non-inferior but superior to rivaroxaban + antiplatelet agent.

Rivaroxaban monotherapy was associated with less major bleeding compared to combination therapy.

Critiques of the Study and Conclusion:

Generalizability: We discussed the specific patient population and characteristics in this study. Does this translate well to our clinical practice here? Does the treatment match how we prescribe these medications to our patients?

Subgroup Analysis: Did all patients have the same benefit or improved safety outcomes, e.g. patients without prior PCI or CABG?

Duration of Study: Are the treatment effects over- or underestimated by the <2-year duration of study?

Methodology: Does the open-label, lack of blinding have an effect on the outcomes? Changing from a non-inferiority to superiority study?

Read the article to find out more.