From the Guidelines
For patients with both peripheral artery disease (PAD) and atrial fibrillation (AFib) who are taking Eliquis (apixaban), adding aspirin is generally not recommended due to the increased risk of bleeding without substantial additional benefit, as supported by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1. This approach prioritizes minimizing the risk of bleeding complications while effectively managing the conditions. The guideline recommends single antiplatelet therapy for patients with symptomatic PAD to reduce the risk of major adverse cardiovascular events (MACE) 1. However, for patients with PAD and AFib, the use of full-intensity oral anticoagulation, such as Eliquis, is indicated for the management of AFib, and adding aspirin may not provide significant additional benefits but increases the risk of bleeding 1. Specific exceptions where combination therapy might be considered include recent stent placement or acute coronary syndrome, but such decisions should be made under close medical supervision 1. It is crucial for patients with both PAD and AFib taking Eliquis to discuss their specific situation with their doctor rather than adding aspirin on their own, as the decision should be based on an individual assessment of risk factors for both clotting and bleeding. Key considerations include the patient's overall health status, the presence of other indications for anticoagulation or antiplatelet therapy, and the potential for bleeding complications. Ultimately, the management of patients with PAD and AFib requires a personalized approach, taking into account the latest clinical guidelines and the individual patient's risk profile 1.
From the Research
Patients with Peripheral Artery Disease (PAD) on Eliquis (apixaban) for Atrial Fibrillation (AFib)
- The use of aspirin in patients with PAD on apixaban for AFib is not directly addressed in the provided studies.
- However, studies suggest that the use of novel oral anticoagulants (NOACs) such as apixaban may be beneficial in reducing cardiovascular events in patients with PAD 2.
- In patients with AFib undergoing coronary artery stenting, dual therapy with a single antiplatelet agent and an oral anticoagulant (such as apixaban) is recommended, with aspirin discontinued in most patients at discharge 3.
- The ARISTOTLE trial found that apixaban was effective in reducing stroke or systemic embolism and death in patients with AFib, regardless of the presence of prior coronary artery disease 4.
- A literature review suggests that combined antiplatelet and anticoagulant therapy may increase the risk of major bleeding with little benefit in decreasing AF-related stroke or cardiovascular events 5.
- Apixaban has been shown to have a lower risk of major bleeding events compared to warfarin, but the clinical evaluation of apixaban is limited by methodological flaws and a lack of comparison with other NOACs such as dabigatran 6.
Aspirin Use in Patients with PAD on Apixaban for AFib
- There is no clear evidence to support the use of aspirin in patients with PAD on apixaban for AFib.
- The Compass trial found that a combination of rivaroxaban with traditional therapy may produce promising results in reducing amputation rates, stroke, cardiac events, and mortality in patients with PAD, but the role of aspirin in this context is not clear 2.
- Further research is needed to determine the optimal treatment strategy for patients with PAD on apixaban for AFib, including the potential use of aspirin 2, 3.