AUGUSTUS Antithrombotic Strategy Calculator
- AUGUSTUS Antithrombotic Strategy – Explanation and Clinical Context
The AUGUSTUS randomized trial (2×2 factorial) compared apixaban versus a vitamin K antagonist and aspirin versus placebo in patients with atrial fibrillation and recent acute coronary syndrome and/or percutaneous coronary intervention who were taking a P2Y12 inhibitor. The principal findings were that apixaban (vs VKA) reduced clinically relevant bleeding and reduced death or hospitalization, while aspirin (vs placebo) increased bleeding without a clear overall reduction in ischemic events over 6 months; however, a short period around the index event (hospitalization / first ~7 days, and in some analyses up to 30 days) may show some ischemic trade-off where aspirin can reduce early stent-thrombosis in selected high-risk PCI scenarios. Therefore, the pragmatic, evidence-based strategy is to favor apixaban + single P2Y12 inhibitor (no routine aspirin), but to consider a short course of aspirin for very high stent-thrombosis risk or complex PCI, then stop aspirin once early ischemic risk diminishes.
How this calculator was constructed: This page computes CHA₂DS₂-VASc (stroke risk) and HAS-BLED (bleeding risk) from your inputs and displays them alongside a trial-based recommendation derived from AUGUSTUS. PRECISE-DAPT is supported as a manual field (paste PRECISE-DAPT if you computed it externally) — PRECISE-DAPT requires a nomogram or calculator (age, hemoglobin, creatinine clearance, white blood cell count, prior bleeding) and is best computed with a validated PRECISE-DAPT tool. Use the combination of these risk estimates to individualize duration of aspirin when clinically indicated (e.g., short aspirin for high ischemic/stent risk vs avoid aspirin in those at high bleeding risk).
References:
Lopes RD, et al. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Patients with Atrial Fibrillation (AUGUSTUS). N Engl J Med. 2019. (primary AUGUSTUS trial).
Clinical interpretation and contemporary expert commentary summarizing trial implications (TCTMD and review summaries).
PRECISE-DAPT derivation/validation (Costa et al., Lancet 2017) — use published PRECISE-DAPT nomogram or validated online calculators for precise score computation.
CHA₂DS₂-VASc score components and clinical interpretation (standard references / calculators).
HAS-BLED bleeding risk score derivation and usage.
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