Dual versus triple antithrombotic therapy in patients undergoing percutaneous coronary intervention-meta-analysis and meta-regression

Nayan Agarwal, Ahmed N. Mahmoud, Mohammad Khalid Mojadidi, Harsh Golwala, Islam Y. Elgendy

Research output: Contribution to journalArticle

Abstract

Background: Anti-thrombotic regimen in patients on long term anticoagulation requiring coronary intervention remains a clinical challenge. Methods: We performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of triple therapy (dual antiplatelet therapy and anticoagulant) with dual therapy (P2Y12 inhibitor and anticoagulant) in patients on long-term anticoagulants after percutaneous coronary intervention (PCI). Major bleeding was the primary outcome. Results: Three observational studies and 3 randomized controlled trials with a total of 6654 patients met our selection criteria. At a mean follow up of 12.5 months major bleeding was lower in dual therapy cohort compared to triple therapy (2.2% vs 5.2%, RR 0.60, 95% CI 0.44–0.81, P = 0.001). No difference was observed between the two groups for major adverse cardiac events (11.8% vs 13.0%, RR 1.03, CI 0.79–1.34, P = 0.85), all-cause mortality (3.9% vs 5.6%, RR 0.94, CI 0.65–1.36, P = 0.76), myocardial infarction (3.7% vs 3.9%, RR 1.12, CI 0.83–1.50, P = 0.47), target vessel revascularization (6.8% vs 7.1%, RR 1.12, CI 0.72–1.74, P = 0.60), thromboembolic events (1.3% vs 1.6%, RR 0.95, CI 0.55–1.64, P = 0.85) and stent thrombosis (1.3% vs 1.4%, RR1.36, CI 0.84–2.21, P = 0.21). Conclusion: For patients undergoing PCI and requiring long term anticoagulation, a strategy of P2Y12 inhibitor plus anticoagulant confers a benefit of less major bleeding with no difference in major adverse cardiac events, mortality, myocardial infarction, target vessel revascularization, stent thrombosis or thromboembolism compared with triple therapy.

Original languageEnglish (US)
JournalCardiovascular Revascularization Medicine
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Percutaneous Coronary Intervention
Meta-Analysis
Anticoagulants
Hemorrhage
Stents
Observational Studies
Thrombosis
Therapeutics
Randomized Controlled Trials
Myocardial Infarction
Mortality
Thromboembolism
Patient Selection

Keywords

  • Anticoagulation
  • Dual therapy
  • Percutaneous coronary intervention
  • Triple therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Dual versus triple antithrombotic therapy in patients undergoing percutaneous coronary intervention-meta-analysis and meta-regression. / Agarwal, Nayan; Mahmoud, Ahmed N.; Mojadidi, Mohammad Khalid; Golwala, Harsh; Elgendy, Islam Y.

In: Cardiovascular Revascularization Medicine, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Dual versus triple antithrombotic therapy in patients undergoing percutaneous coronary intervention-meta-analysis and meta-regression",
abstract = "Background: Anti-thrombotic regimen in patients on long term anticoagulation requiring coronary intervention remains a clinical challenge. Methods: We performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of triple therapy (dual antiplatelet therapy and anticoagulant) with dual therapy (P2Y12 inhibitor and anticoagulant) in patients on long-term anticoagulants after percutaneous coronary intervention (PCI). Major bleeding was the primary outcome. Results: Three observational studies and 3 randomized controlled trials with a total of 6654 patients met our selection criteria. At a mean follow up of 12.5 months major bleeding was lower in dual therapy cohort compared to triple therapy (2.2{\%} vs 5.2{\%}, RR 0.60, 95{\%} CI 0.44–0.81, P = 0.001). No difference was observed between the two groups for major adverse cardiac events (11.8{\%} vs 13.0{\%}, RR 1.03, CI 0.79–1.34, P = 0.85), all-cause mortality (3.9{\%} vs 5.6{\%}, RR 0.94, CI 0.65–1.36, P = 0.76), myocardial infarction (3.7{\%} vs 3.9{\%}, RR 1.12, CI 0.83–1.50, P = 0.47), target vessel revascularization (6.8{\%} vs 7.1{\%}, RR 1.12, CI 0.72–1.74, P = 0.60), thromboembolic events (1.3{\%} vs 1.6{\%}, RR 0.95, CI 0.55–1.64, P = 0.85) and stent thrombosis (1.3{\%} vs 1.4{\%}, RR1.36, CI 0.84–2.21, P = 0.21). Conclusion: For patients undergoing PCI and requiring long term anticoagulation, a strategy of P2Y12 inhibitor plus anticoagulant confers a benefit of less major bleeding with no difference in major adverse cardiac events, mortality, myocardial infarction, target vessel revascularization, stent thrombosis or thromboembolism compared with triple therapy.",
keywords = "Anticoagulation, Dual therapy, Percutaneous coronary intervention, Triple therapy",
author = "Nayan Agarwal and Mahmoud, {Ahmed N.} and Mojadidi, {Mohammad Khalid} and Harsh Golwala and Elgendy, {Islam Y.}",
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T1 - Dual versus triple antithrombotic therapy in patients undergoing percutaneous coronary intervention-meta-analysis and meta-regression

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AU - Mahmoud, Ahmed N.

AU - Mojadidi, Mohammad Khalid

AU - Golwala, Harsh

AU - Elgendy, Islam Y.

PY - 2019/1/1

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N2 - Background: Anti-thrombotic regimen in patients on long term anticoagulation requiring coronary intervention remains a clinical challenge. Methods: We performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of triple therapy (dual antiplatelet therapy and anticoagulant) with dual therapy (P2Y12 inhibitor and anticoagulant) in patients on long-term anticoagulants after percutaneous coronary intervention (PCI). Major bleeding was the primary outcome. Results: Three observational studies and 3 randomized controlled trials with a total of 6654 patients met our selection criteria. At a mean follow up of 12.5 months major bleeding was lower in dual therapy cohort compared to triple therapy (2.2% vs 5.2%, RR 0.60, 95% CI 0.44–0.81, P = 0.001). No difference was observed between the two groups for major adverse cardiac events (11.8% vs 13.0%, RR 1.03, CI 0.79–1.34, P = 0.85), all-cause mortality (3.9% vs 5.6%, RR 0.94, CI 0.65–1.36, P = 0.76), myocardial infarction (3.7% vs 3.9%, RR 1.12, CI 0.83–1.50, P = 0.47), target vessel revascularization (6.8% vs 7.1%, RR 1.12, CI 0.72–1.74, P = 0.60), thromboembolic events (1.3% vs 1.6%, RR 0.95, CI 0.55–1.64, P = 0.85) and stent thrombosis (1.3% vs 1.4%, RR1.36, CI 0.84–2.21, P = 0.21). Conclusion: For patients undergoing PCI and requiring long term anticoagulation, a strategy of P2Y12 inhibitor plus anticoagulant confers a benefit of less major bleeding with no difference in major adverse cardiac events, mortality, myocardial infarction, target vessel revascularization, stent thrombosis or thromboembolism compared with triple therapy.

AB - Background: Anti-thrombotic regimen in patients on long term anticoagulation requiring coronary intervention remains a clinical challenge. Methods: We performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of triple therapy (dual antiplatelet therapy and anticoagulant) with dual therapy (P2Y12 inhibitor and anticoagulant) in patients on long-term anticoagulants after percutaneous coronary intervention (PCI). Major bleeding was the primary outcome. Results: Three observational studies and 3 randomized controlled trials with a total of 6654 patients met our selection criteria. At a mean follow up of 12.5 months major bleeding was lower in dual therapy cohort compared to triple therapy (2.2% vs 5.2%, RR 0.60, 95% CI 0.44–0.81, P = 0.001). No difference was observed between the two groups for major adverse cardiac events (11.8% vs 13.0%, RR 1.03, CI 0.79–1.34, P = 0.85), all-cause mortality (3.9% vs 5.6%, RR 0.94, CI 0.65–1.36, P = 0.76), myocardial infarction (3.7% vs 3.9%, RR 1.12, CI 0.83–1.50, P = 0.47), target vessel revascularization (6.8% vs 7.1%, RR 1.12, CI 0.72–1.74, P = 0.60), thromboembolic events (1.3% vs 1.6%, RR 0.95, CI 0.55–1.64, P = 0.85) and stent thrombosis (1.3% vs 1.4%, RR1.36, CI 0.84–2.21, P = 0.21). Conclusion: For patients undergoing PCI and requiring long term anticoagulation, a strategy of P2Y12 inhibitor plus anticoagulant confers a benefit of less major bleeding with no difference in major adverse cardiac events, mortality, myocardial infarction, target vessel revascularization, stent thrombosis or thromboembolism compared with triple therapy.

KW - Anticoagulation

KW - Dual therapy

KW - Percutaneous coronary intervention

KW - Triple therapy

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