Assessment of Quitting Versus Using Aspirin Therapy In Patients Treated With Oral Anticoagulation for Atrial Fibrillation or Other Indication With Stabilized Coronary Artery Disease

Prior treatment

• Any coronary event within 6 months prior to randomization
• Planned PCI within the next 6 months after randomization or subject requiring P2Y12 receptor antagonist therapy

Other illness

• High risk of bleeding defined as recent (≤6 months) ISTH major bleeding event
• Constitutional or acquired haemorrhagic disease including gastrointestinal bleeding and thrombocytopenia
• Stroke within 1 month or any history of hemorrhagic stroke
• Any contraindication to aspirin (ASA) or any of these excipients or other NSAIDs (hypersensitivity, allergy, active bleeding)
• Evolutionary gastroduodenal ulcer
• Severe renal insufficiency
• Severe hepatic insufficiency
• Severe, uncontrolled heart failure

Other

• Any contraindication to anticoagulant
• History (s) of asthma induced by the administration of salicylates or substances of close activity (especially NSAIDs)
• Any other gastroduodenal history
• Lactose intolerance
• Pregnancy
• Breastfeeding patients
• Unable (protected adults : tutorship, curatorship) orunwilling to consent

• Patients >18 year-old
• All patients that need anticoagulation with direct oral anticoagulant (DOAC) or vitamin K antagonist (VKA) for AF (paroxysmal, persistent or permanent) or other indication and have a stabilized CAD (free from MI, or coronary revascularization in the past year) but remain at high residual risk of recurrent coronary and vascular events. The use of DOAC will be promoted as recommended by guidelines.
• Two different categories of patients could be included in the study, i) patients treated at the time of inclusion with the association of OAC and single antiplatelet therapy, it will be tested for them aspirin vs. interruption of antiplatelet therapy ii) patients treated with OAC alone at the time of inclusion, it will be tested for them administration of aspirin vs. no additional treatment with aspirin.
• High-risk of coronary and vascular event is defined as follow :
  • History of PCI during an ACS involving placement of ≥1 stent(s) since >6 months.
  • History of PCI (>6 months) outside the context of ACS but with high-risk features of ischemic event recurrences defined as: diabetes, or diffuse multivessel disease (defined by the involvement of the 3 coronary vessels), or chronic kidney disease (creatinine clearance < 50ml/min), or prior stent thrombosis, or complex PCI (defined by: stenting of the last remaining patent coronary artery, left main, at least 3 stents implanted and/or 3 lesions treated, bifurcation with two stents, length of stent >60mm and chronic total coronary occlusion) or the presence of peripheral artery disease (previous limb revascularization bypass or percutaneous angioplasty, previous limb or foot amputation for arterial vascular disease, history of intermittent claudication of peripheral artery stenosis (≥50%) ,previous carotid revascularization or carotid stenosis ≥50%).
• Women of childbearing potential with effective contraception defined as
  • combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation :
  • oral
  • intravaginal
  • transdermal
  • progestogen-only hormonal contraception associated with inhibition of ovulation :
  • oral
  • injectable
  • implantable
  • intrauterine device (IUD)
  • intrauterine hormone-releasing system ( IUS)
  • bilateral tubal occlusion
  • vasectomised partner
  • sexual abstinence