Safety and Efficacy of Dual Versus Triple Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention

Nayan Agarwal, Ankur Jain, Ahmed N. Mahmoud, Rohit Bishnoi, Harsh Golwala, Ashkan Karimi, Mohammad Khalid Mojadidi, Jalaj Garg, Tanush Gupta, Nimesh Kirit Patel, Siddharth Wayangankar, R. David Anderson

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background Choosing an antithrombotic regimen after coronary intervention in patients with concomitant indication for anticoagulation is a challenge commonly encountered by clinicians. 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 (single antiplatelet therapy and anticoagulant) in patients taking long-term anticoagulants after percutaneous coronary intervention. Major bleeding was the primary outcome. Random effects overall risk ratios (RRs) were calculated using the DerSimonian and Laird model. Results Nine observational studies and 2 randomized controlled trials with a total of 7276 patients met our selection criteria. At a mean follow-up of 10.8 months major bleeding was higher in the triple therapy cohort compared with dual therapy (6.6% vs 3.8%; RR 1.54; 95% confidence interval [CI], 1.2-1.98; P <.01). No difference was observed between the 2 groups for all-cause mortality (RR 0.98; 95% CI, 0.68-1.43; P =.93), major adverse cardiac events (RR 1.03; 95% CI, 0.8-1.32; P =.83), thromboembolic events (RR 1.02; 95% CI, 0.49-2.10; P =.96), myocardial infarction (RR 0.85; 95% CI, 0.67-1.09; P =.21), stent thrombosis (RR 0.77; 95% CI, 0.46-1.3; P =.33), and target vessel revascularization (RR 0.87; 95% CI, 0.66-1.15; P =.33). Conclusion In patients receiving anticoagulant therapy, a strategy of single antiplatelet therapy confers a benefit of less major bleeding with no difference in all-cause mortality, cardiovascular mortality, major adverse cardiac events, myocardial infarction, stent thrombosis, or thromboembolic event rate compared with dual antiplatelet therapy.

Original languageEnglish (US)
Pages (from-to)1280-1289
Number of pages10
JournalAmerican Journal of Medicine
Volume130
Issue number11
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

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Percutaneous Coronary Intervention
Odds Ratio
Safety
Confidence Intervals
Anticoagulants
Therapeutics
Hemorrhage
Stents
Observational Studies
Mortality
Thrombosis
Randomized Controlled Trials
Myocardial Infarction
Patient Selection
Meta-Analysis

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Safety and Efficacy of Dual Versus Triple Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention. / Agarwal, Nayan; Jain, Ankur; Mahmoud, Ahmed N.; Bishnoi, Rohit; Golwala, Harsh; Karimi, Ashkan; Mojadidi, Mohammad Khalid; Garg, Jalaj; Gupta, Tanush; Patel, Nimesh Kirit; Wayangankar, Siddharth; Anderson, R. David.

In: American Journal of Medicine, Vol. 130, No. 11, 01.11.2017, p. 1280-1289.

Research output: Contribution to journalArticle

Agarwal, N, Jain, A, Mahmoud, AN, Bishnoi, R, Golwala, H, Karimi, A, Mojadidi, MK, Garg, J, Gupta, T, Patel, NK, Wayangankar, S & Anderson, RD 2017, 'Safety and Efficacy of Dual Versus Triple Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention', American Journal of Medicine, vol. 130, no. 11, pp. 1280-1289. https://doi.org/10.1016/j.amjmed.2017.03.057
Agarwal, Nayan ; Jain, Ankur ; Mahmoud, Ahmed N. ; Bishnoi, Rohit ; Golwala, Harsh ; Karimi, Ashkan ; Mojadidi, Mohammad Khalid ; Garg, Jalaj ; Gupta, Tanush ; Patel, Nimesh Kirit ; Wayangankar, Siddharth ; Anderson, R. David. / Safety and Efficacy of Dual Versus Triple Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention. In: American Journal of Medicine. 2017 ; Vol. 130, No. 11. pp. 1280-1289.
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abstract = "Background Choosing an antithrombotic regimen after coronary intervention in patients with concomitant indication for anticoagulation is a challenge commonly encountered by clinicians. 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 (single antiplatelet therapy and anticoagulant) in patients taking long-term anticoagulants after percutaneous coronary intervention. Major bleeding was the primary outcome. Random effects overall risk ratios (RRs) were calculated using the DerSimonian and Laird model. Results Nine observational studies and 2 randomized controlled trials with a total of 7276 patients met our selection criteria. At a mean follow-up of 10.8 months major bleeding was higher in the triple therapy cohort compared with dual therapy (6.6{\%} vs 3.8{\%}; RR 1.54; 95{\%} confidence interval [CI], 1.2-1.98; P <.01). No difference was observed between the 2 groups for all-cause mortality (RR 0.98; 95{\%} CI, 0.68-1.43; P =.93), major adverse cardiac events (RR 1.03; 95{\%} CI, 0.8-1.32; P =.83), thromboembolic events (RR 1.02; 95{\%} CI, 0.49-2.10; P =.96), myocardial infarction (RR 0.85; 95{\%} CI, 0.67-1.09; P =.21), stent thrombosis (RR 0.77; 95{\%} CI, 0.46-1.3; P =.33), and target vessel revascularization (RR 0.87; 95{\%} CI, 0.66-1.15; P =.33). Conclusion In patients receiving anticoagulant therapy, a strategy of single antiplatelet therapy confers a benefit of less major bleeding with no difference in all-cause mortality, cardiovascular mortality, major adverse cardiac events, myocardial infarction, stent thrombosis, or thromboembolic event rate compared with dual antiplatelet therapy.",
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T1 - Safety and Efficacy of Dual Versus Triple Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention

AU - Agarwal, Nayan

AU - Jain, Ankur

AU - Mahmoud, Ahmed N.

AU - Bishnoi, Rohit

AU - Golwala, Harsh

AU - Karimi, Ashkan

AU - Mojadidi, Mohammad Khalid

AU - Garg, Jalaj

AU - Gupta, Tanush

AU - Patel, Nimesh Kirit

AU - Wayangankar, Siddharth

AU - Anderson, R. David

PY - 2017/11/1

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N2 - Background Choosing an antithrombotic regimen after coronary intervention in patients with concomitant indication for anticoagulation is a challenge commonly encountered by clinicians. 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 (single antiplatelet therapy and anticoagulant) in patients taking long-term anticoagulants after percutaneous coronary intervention. Major bleeding was the primary outcome. Random effects overall risk ratios (RRs) were calculated using the DerSimonian and Laird model. Results Nine observational studies and 2 randomized controlled trials with a total of 7276 patients met our selection criteria. At a mean follow-up of 10.8 months major bleeding was higher in the triple therapy cohort compared with dual therapy (6.6% vs 3.8%; RR 1.54; 95% confidence interval [CI], 1.2-1.98; P <.01). No difference was observed between the 2 groups for all-cause mortality (RR 0.98; 95% CI, 0.68-1.43; P =.93), major adverse cardiac events (RR 1.03; 95% CI, 0.8-1.32; P =.83), thromboembolic events (RR 1.02; 95% CI, 0.49-2.10; P =.96), myocardial infarction (RR 0.85; 95% CI, 0.67-1.09; P =.21), stent thrombosis (RR 0.77; 95% CI, 0.46-1.3; P =.33), and target vessel revascularization (RR 0.87; 95% CI, 0.66-1.15; P =.33). Conclusion In patients receiving anticoagulant therapy, a strategy of single antiplatelet therapy confers a benefit of less major bleeding with no difference in all-cause mortality, cardiovascular mortality, major adverse cardiac events, myocardial infarction, stent thrombosis, or thromboembolic event rate compared with dual antiplatelet therapy.

AB - Background Choosing an antithrombotic regimen after coronary intervention in patients with concomitant indication for anticoagulation is a challenge commonly encountered by clinicians. 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 (single antiplatelet therapy and anticoagulant) in patients taking long-term anticoagulants after percutaneous coronary intervention. Major bleeding was the primary outcome. Random effects overall risk ratios (RRs) were calculated using the DerSimonian and Laird model. Results Nine observational studies and 2 randomized controlled trials with a total of 7276 patients met our selection criteria. At a mean follow-up of 10.8 months major bleeding was higher in the triple therapy cohort compared with dual therapy (6.6% vs 3.8%; RR 1.54; 95% confidence interval [CI], 1.2-1.98; P <.01). No difference was observed between the 2 groups for all-cause mortality (RR 0.98; 95% CI, 0.68-1.43; P =.93), major adverse cardiac events (RR 1.03; 95% CI, 0.8-1.32; P =.83), thromboembolic events (RR 1.02; 95% CI, 0.49-2.10; P =.96), myocardial infarction (RR 0.85; 95% CI, 0.67-1.09; P =.21), stent thrombosis (RR 0.77; 95% CI, 0.46-1.3; P =.33), and target vessel revascularization (RR 0.87; 95% CI, 0.66-1.15; P =.33). Conclusion In patients receiving anticoagulant therapy, a strategy of single antiplatelet therapy confers a benefit of less major bleeding with no difference in all-cause mortality, cardiovascular mortality, major adverse cardiac events, myocardial infarction, stent thrombosis, or thromboembolic event rate compared with dual antiplatelet therapy.

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