{"id":8596,"date":"2025-09-13T14:59:20","date_gmt":"2025-09-13T11:59:20","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8596"},"modified":"2025-09-13T14:59:20","modified_gmt":"2025-09-13T11:59:20","slug":"aquatic-trial-aspirin-anticoagulation","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/aquatic-trial-aspirin-anticoagulation\/","title":{"rendered":"AQUATIC Trial \u2013 Aspirin + Anticoagulation"},"content":{"rendered":"<div>AQUATIC Trial \u2013 Aspirin + Anticoagulation<\/div>\n<div><\/div>\n<div>Source: Medscape, ESC 2025, Sept 11, 2025<\/div>\n<div><\/div>\n<div><span> 1. Background<\/span><\/div>\n<div><span> \u2022 Many patients with chronic CAD + AF receive both aspirin and anticoagulation.<\/span><\/div>\n<div><span> \u2022 AQUATIC tested if dual therapy (aspirin + OAC) is better than OAC alone.<\/span><\/div>\n<div><span> 2. Design<\/span><\/div>\n<div><span> \u2022 ~900 patients, mean age 72, mostly male, high ischemic risk (prior MI, CHA\u2082DS\u2082-VASc ~4).<\/span><\/div>\n<div><span> \u2022 Anticoagulation: 89% DOAC, rest warfarin.<\/span><\/div>\n<div><span> \u2022 Randomized to OAC + aspirin vs OAC + placebo.<\/span><\/div>\n<div><span> 3. Results (2 years, stopped early for harm)<\/span><\/div>\n<div><span> \u2022 Primary events: 16.9% dual vs 12.1% OAC alone (HR 1.53).<\/span><\/div>\n<div><span> \u2022 All-cause death: 13.4% vs 8.4% (HR 1.72).<\/span><\/div>\n<div><span> \u2022 Major bleeding: 10.2% vs 3.4% (HR 3.3).<\/span><\/div>\n<div><span> \u2022 Conclusion: Combination clearly worse.<\/span><\/div>\n<div><span> 4. Triple Therapy (ACC\/AHA &amp; ESC Guidelines)<\/span><\/div>\n<div><span> \u2022 Triple therapy (OAC + aspirin + clopidogrel) is used only briefly after PCI with stent in patients who also need anticoagulation.<\/span><\/div>\n<div><span> \u2022 Recommended duration: \u22641 week, up to 1 month in very high ischemic risk cases (complex PCI, recent ACS, diffuse multivessel coronary disease with diabetes or chronic kidney disease,\u00a0 or prior stent thrombosis).<\/span><\/div>\n<div><span> \u2022 Then \u2192 step down to dual therapy (OAC + clopidogrel) for the rest of the 6\u201312 month post-PCI window.<\/span><\/div>\n<div><span> \u2022 Beyond 12 months \u2192 OAC alone is best.<\/span><\/div>\n<div><span> 5. Lessons<\/span><\/div>\n<div><span> \u2022 Large absolute harm: NNH = 21 for ischemic events, 15 for bleeding.<\/span><\/div>\n<div><span> \u2022 Results align with AFIRE and EPIC-CAD.<\/span><\/div>\n<div><span> \u2022 The coagulation system is delicate \u2014 combining aspirin + OAC causes additive harm, not additive benefit.<\/span><\/div>\n<div><span> 6. Take-home<\/span><\/div>\n<div><span> \u2022 Outside the 6\u201312 months post-stent window, in patients with chronic CAD and AF:<\/span><\/div>\n<div><span> \u2022 OAC alone is best.<\/span><\/div>\n<div><span> \u2022 Dual or triple therapy is the wrong answer for long-term management.<\/span><\/div>\n<div><\/div>\n<div>https:\/\/click.mail.medscape.com\/?qs=7833e4a60709dd3378f39a38e24e995b6747c1cbf03239d20c03a0cc3a53db1e4c3bc75aa234561931b1267d5a2d559643f05200bbec926cb5d65d19137e793e<\/div>\n","protected":false},"excerpt":{"rendered":"<p>AQUATIC Trial \u2013 Aspirin + Anticoagulation Source: Medscape, ESC 2025, Sept 11, 2025 1. Background \u2022 Many patients with chronic CAD + AF receive both aspirin and anticoagulation. \u2022 AQUATIC tested if dual therapy (aspirin + OAC) is better than OAC alone. 2. Design \u2022 ~900 patients, mean age 72, mostly male, high ischemic risk [&hellip;]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8596","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8596","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8596"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8596\/revisions"}],"predecessor-version":[{"id":8597,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8596\/revisions\/8597"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8596"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8596"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8596"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}