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AFIRE Study Algorithm (AF + Stable CAD) Calculator

  • Age (years)
  • Years since last coronary revascularization (PCI/CABG) or time since angiographic CAD diagnosis Enter 0 if < 1 year or if no revascularization but CAD was recently diagnosed.
  • Are you currently taking an antiplatelet agent (aspirin or P2Y12 inhibitor)?
  • High bleeding risk? (ARC-HBR or clinician judgment)
  • AFIRE Study Algorithm — Practical explanation and context
    This calculator applies the core enrollment and outcome insights from the AFIRE randomized trial (Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease) to provide a pragmatic recommendation: patients with atrial fibrillation and stable CAD who are at least 1 year past revascularization (or have angiographically confirmed stable CAD) were randomized in AFIRE and had similar ischemic outcomes but less major bleeding with rivaroxaban monotherapy versus rivaroxaban plus a single antiplatelet agent. Therefore, for patients meeting these stability/time criteria, OAC monotherapy (as used in AFIRE) is a reasonable strategy; continuing or restarting antiplatelet therapy should be reserved for clear ongoing ischemic indications and after weighing bleeding risk.

    This tool is an algorithmic aide — not a substitute for clinical judgment. For patients <1 year after PCI/CABG, those with recent ACS, complex coronary stents, recent thrombosis, or other specific indications for antiplatelet therapy, early combination therapy may still be indicated and specialist input is required. High bleeding risk (e.g., ARC-HBR features) pushes the balance toward monotherapy. Always individualize treatment (dose selection per local DOAC guidance, renal function, drug interactions, and guideline recommendations).

    References:
    Yasuda S, et al. Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease (AFIRE). N Engl J Med. 2019.
    ACC / trial summaries and clinical overviews: AFIRE trial interpretation & clinical implications.
    Sub-analyses and bleeding impact analyses from AFIRE and subsequent studies highlighting bleeding → adverse outcomes and the importance of individualized balance.