Thromb Haemost 2025; 125(08): 744-746
DOI: 10.1055/a-2622-8652
Invited Editorial Focus

Optimizing Use of Antithrombotics and Overcoming Therapeutic Inertia: Lessons from the AEGIS Trial

Authors

  • Giulio Francesco Romiti

    1   Department of Translational and Precision Medicine, Sapienza – University of Rome, Rome, Italy
    2   Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom


Graphical Abstract



Publication History

Received: 27 May 2025

Accepted: 27 May 2025

Article published online:
10 June 2025

© 2025. Thieme. All rights reserved.

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  • References

  • 1 Scott IA, Gray LC, Martin JH, Mitchell CA. Minimizing inappropriate medications in older populations: a 10-step conceptual framework. Am J Med 2012; 125 (06) 529-37.e4
  • 2 Bhat A, Karthikeyan S, Chen HHL, Gan GCH, Denniss AR, Tan TC. Barriers to guideline-directed anticoagulation in patients with atrial fibrillation: new approaches to an old problem. Can J Cardiol 2023; 39 (05) 625-636
  • 3 Philippe E, Henrard S, Boland B, Marien S. Inappropriate combined antiplatelet and anticoagulant therapy in older patients with atrial fibrillation: trend over time (2009–18). Drugs Aging 2023; 40 (03) 273-283
  • 4 Amirtabar A, Vazquez SR, Saunders J, Witt DM. Antiplatelet therapy indication in patients also prescribed direct oral anticoagulants. J Thromb Thrombolysis 2023; 55 (01) 185-188
  • 5 Steinberg BA, Kim S, Piccini JP. et al; ORBIT-AF Investigators and Patients. Use and associated risks of concomitant aspirin therapy with oral anticoagulation in patients with atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry. Circulation 2013; 128 (07) 721-728
  • 6 Fox KAA, Velentgas P, Camm AJ. et al; GARFIELD-AF Investigators. GARFIELD-AF Investigators. Outcomes associated with oral anticoagulants plus antiplatelets in patients with newly diagnosed atrial fibrillation. JAMA Netw Open 2020; 3 (02) e200107
  • 7 Cho MS, Kang D-Y, Ahn J-M. et al; EPIC-CAD Investigators. Edoxaban antithrombotic therapy for atrial fibrillation and stable coronary artery disease. N Engl J Med 2024; 391 (22) 2075-2086
  • 8 Yasuda S, Kaikita K, Akao M. et al; AFIRE Investigators. Antithrombotic therapy for atrial fibrillation with stable coronary disease. N Engl J Med 2019; 381 (12) 1103-1113
  • 9 Abraham NS, Noseworthy PA, Inselman J. et al. Risk of gastrointestinal bleeding increases with combinations of antithrombotic agents and patient age. Clin Gastroenterol Hepatol 2020; 18 (02) 337-346.e19
  • 10 Kurlander JE, Helminski D, Tao X. et al. An intervention to reduce antiplatelet use without gastroprotection in patients using warfarin: the AEGIS cluster randomized trial. Thromb Haemost 2025; 125 (08) 733-743
  • 11 Landolina D, Ammirabile N, Capodanno D. Strategies for tailored antiplatelet therapy after percutaneous coronary intervention: unraveling complexities, embracing nuances. Thromb Haemost 2024; 124 (05) 497-499
  • 12 Gorog DA, Jeyalan V, Markides RIL, Navarese EP, Jeong Y-H, Farag M. Comparison of DE-escalation of DAPT intensity or duration in east Asian and western patients with ACS undergoing PCI: a systematic review and meta-analysis. Thromb Haemost 2023; 123 (08) 773-792
  • 13 Gorog DA, Ferreiro JL, Ahrens I. et al. De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis. Nat Rev Cardiol 2023; 20 (12) 830-844
  • 14 Kang D-S, Yang P-S, Kim D. et al. Racial differences in bleeding risk: an ecological epidemiological study comparing Korea and United Kingdom subjects. Thromb Haemost 2024; 124 (09) 842-851
  • 15 Kang D-S, Yang P-S, Kim D. et al. Racial differences in ischemic and hemorrhagic stroke: an ecological epidemiological study. Thromb Haemost 2024; 124 (09) 883-892
  • 16 Romiti GF, Corica B, Proietti M. et al; GLORIA-AF Investigators. Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry. EClinicalMedicine 2023; 63: 102039
  • 17 Marcum ZA, Gellad WF. Medication adherence to multidrug regimens. Clin Geriatr Med 2012; 28 (02) 287-300
  • 18 Chang H-C, Chan Y-H, Kuo L, Chao T-F. Patient care pathways and risk assessments in patients with atrial fibrillation: a comparison of Asian versus non-Asian cohorts. Thromb Haemost 2025; (e-pub ahead of print).
  • 19 Guo Y, Lane DA, Wang L. et al; mAF-App II Trial Investigators. Mobile health technology to improve care for patients with atrial fibrillation. J Am Coll Cardiol 2020; 75 (13) 1523-1534
  • 20 Treewaree S, Lip GYH, Krittayaphong R. Non-vitamin K antagonist oral anticoagulant, warfarin, and ABC pathway adherence on hierarchical outcomes: Win Ratio analysis of the COOL-AF registry. Thromb Haemost 2024; 124 (01) 69-79
  • 21 Chu M, Zhang S, Gong J. et al; MIRACLE-AF Investigators. Telemedicine-based integrated management of atrial fibrillation in village clinics: a cluster randomized trial. Nat Med 2025; 31 (04) 1276-1285