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Coronary interventions

Short-duration triple antithrombotic therapy for atrial fibrillation patients who require coronary stenting: results of the SAFE-A study

EuroIntervention 2020;16:e164-e172. DOI: 10.4244/EIJ-D-19-00920

1. Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan; 2. Department of Cardiology, Ibaraki Prefectural Central Hospital, Ibaraki, Japan; 3. Department of Biostatistics, Tsukuba Clinical Research & Development Organization, University of Tsukuba, Tsukuba City, Ibaraki, Japan; 4. Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan

Aims: We aimed to determine whether shortening the duration of P2Y12 inhibitor therapy can reduce the risk of bleeding without increasing the risk of major adverse cardiovascular events following coronary stenting in patients with atrial fibrillation (AF).

Methods and results: The SAFE-A is a randomised controlled trial that compared one-month and six-month P2Y12 inhibitor therapy, in combination with aspirin and apixaban for patients with AF who require coronary stenting. The primary endpoint was the incidence of any bleeding events, defined as Thrombolysis In Myocardial Infarction major/minor bleeding, bleeding with various Bleeding Academic Research Consortium grades, or bleeding requiring blood transfusion within 12 months after stenting. The study aimed to enrol 600 patients but enrolment was slow. Enrolment was terminated prematurely after enrolling 210 patients (72.7±8.2 years; 81% male). The incidence of the primary endpoint did not differ between the one-month and six-month groups (11.8% vs 16.0%; hazard ratio [HR] 0.70, 95% confidence interval [CI]: 0.33-1.47; p=0.35).

Conclusions: The study evaluated the safety of withdrawing the P2Y12 inhibitor from triple antithrombotic prescription one month after coronary stenting. However, enrolment was prematurely terminated because it was slow. Therefore, statistical power was not sufficient to assess the differences in the primary endpoint.

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