BACKGROUND Direct oral anticoagulants (DOACs) are replacing warfarin for stroke prevention in patients with atrial fibrillation (AF). OBJECTIVE To assess the effectiveness and safety of concomitant treatment with antiplatelet-DOAC compared to antiplatelet-warfarin in patients with acute coronary syndrome (ACS) and AF. DESIGN Retrospective propensity score-matched cohort study using United States-based commercial healthcare database from January 2016 to June 2019. PARTICIPANTS New-users of antiplatelet-DOAC and antiplatelet-warfarin who initiated the combined therapy within 30 days following incident ACS diagnosis. MEASUREMENTS Primary study outcomes were recurrent cardiovascular diseases (CVD) (ie, a composite of stroke and myocardial infarction) and major bleeding events identified via discharge diagnoses. We controlled for potential confounders via propensity score matching (PSM). We generated marginal hazard ratios (HRs) via Cox proportional hazards regression using a robust variance estimator while adjusting for calendar time. RESULTS After PSM, a total of 2,472 persons were included (1,236 users of antiplatelet-DOAC and 1,236 users of antiplatelet-warfarin). The use of antiplatelet-DOAC (vs. antiplatelet-warfarin) was associated with a reduced rate of recurrent CVD (adjusted HR 0.72, 95% confidence interval [CI], 0.56-0.92) and major bleeding events (adjusted HR, 0.49, 95% CI 0.33-0.72). LIMITATIONS Residual confounding. CONCLUSIONS In real-world data of AF patients with concurrent ACS, the use of antiplatelet-DOAC following ACS diagnosis was associated with a lower rate of recurrent CVD and major bleeding events compared with antiplatelet-warfarin. These findings highlight a potential promising role for DOACs in patients with ACS and AF requiring combined antiplatelet therapy.

中文翻译：

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急性冠脉综合征和心房颤动患者抗血小板和直接口服抗凝剂的心血管和大出血结果：基于人群的分析。

背景直接口服抗凝剂 (DOAC) 正在取代华法林，用于预防房颤 (AF) 患者的卒中。目的 评估与抗血小板-华法林相比，抗血小板-DOAC 联合治疗在急性冠脉综合征 (ACS) 和 AF 患者中的有效性和安全性。设计 2016 年 1 月至 2019 年 6 月使用美国商业医疗保健数据库的回顾性倾向评分匹配队列研究。参与者 ACS 诊断后 30 天内开始联合治疗的抗血小板-DOAC 和抗血小板-华法林的新用户。测量 主要研究结果是复发性心血管疾病 (CVD)（即中风和心肌梗塞的复合）和通过出院诊断确定的主要出血事件。我们通过倾向评分匹配 (PSM) 控制潜在的混杂因素。我们在调整日历时间的同时，使用稳健的方差估计器通过 Cox 比例风险回归生成边际风险比 (HR)。结果 PSM 后，共有 2,472 人被纳入（1,236 名抗血小板-DOAC 使用者和 1,236 名抗血小板-华法林使用者）。使用抗血小板-DOAC（与抗血小板-华法林相比）与 CVD 复发率降低（调整后的 HR 0.72，95% 置信区间 [CI]，0.56-0.92）和大出血事件（调整后的 HR，0.49，95 % CI 0.33-0.72)。限制 残留混杂。结论 在并发 ACS 的 AF 患者的真实世界数据中，与抗血小板华法林相比，ACS 诊断后使用抗血小板 DOAC 与较低的 CVD 复发率和大出血事件相关。这些发现强调了 DOAC 在需要联合抗血小板治疗的 ACS 和 AF 患者中的潜在有希望的作用。