Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention

A systematic review and meta-analysis of randomized clinical trials

Harsh Golwala, Christopher P. Cannon, Ph Gabriel Steg, Gheorghe Doros, Arman Qamar, Stephen G. Ellis, Jonas Oldgren, Jurrien M. Ten Berg, Takeshi Kimura, Stefan H. Hohnloser, Gregory Y.H. Lip, Deepak L. Bhatt

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Aims Of patients with atrial fibrillation (AF), approximately 10% undergo percutaneous coronary intervention (PCI). We studied the safety and efficacy of dual vs. triple antithrombotic therapy (DAT vs. TAT) in this population. Methods and results A systematic review and meta-analysis was conducted using PubMed, Embase, EBSCO, Cochrane database of systematic reviews, Web of Science, and relevant meeting abstracts for Phase 3, randomized trials that compared DAT vs. TAT in patients with AF following PCI. Four trials including 5317 patients were included, of whom 3039 (57%) received DAT. Compared with the TAT arm, Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding showed a reduction by 47% in the DAT arm [4.3% vs. 9.0%; hazard ratio (HR) 0.53, 95% credible interval (CrI) 0.36-0.85, I2 = 42.9%]. In addition, there was no difference in the trial-defined major adverse cardiac events (MACE) (10.4% vs. 10.0%, HR 0.85, 95% CrI 0.48-1.29, I2 = 58.4%), or in individual outcomes of all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, or stroke between the two arms. Conclusion Compared with TAT, DAT shows a reduction in TIMI major or minor bleeding by 47% with comparable outcomes of MACE. Our findings support the concept that DAT may be a better option than TAT in many patients with AF following PCI.

Original languageEnglish (US)
Pages (from-to)1726-1735
Number of pages10
JournalEuropean heart journal
Volume39
Issue number19
DOIs
StatePublished - May 14 2018
Externally publishedYes

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Percutaneous Coronary Intervention
Atrial Fibrillation
Meta-Analysis
Randomized Controlled Trials
Safety
Myocardial Infarction
Hemorrhage
Therapeutics
PubMed
Stents
Thrombosis
Stroke
Databases
Mortality
Population

Keywords

  • Antithrombotic therapy
  • Atrial fibrillation
  • Dual therapy
  • Percutaneous coronary intervention
  • Triple therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention : A systematic review and meta-analysis of randomized clinical trials. / Golwala, Harsh; Cannon, Christopher P.; Steg, Ph Gabriel; Doros, Gheorghe; Qamar, Arman; Ellis, Stephen G.; Oldgren, Jonas; Ten Berg, Jurrien M.; Kimura, Takeshi; Hohnloser, Stefan H.; Lip, Gregory Y.H.; Bhatt, Deepak L.

In: European heart journal, Vol. 39, No. 19, 14.05.2018, p. 1726-1735.

Research output: Contribution to journalArticle

Golwala, Harsh ; Cannon, Christopher P. ; Steg, Ph Gabriel ; Doros, Gheorghe ; Qamar, Arman ; Ellis, Stephen G. ; Oldgren, Jonas ; Ten Berg, Jurrien M. ; Kimura, Takeshi ; Hohnloser, Stefan H. ; Lip, Gregory Y.H. ; Bhatt, Deepak L. / Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention : A systematic review and meta-analysis of randomized clinical trials. In: European heart journal. 2018 ; Vol. 39, No. 19. pp. 1726-1735.
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abstract = "Aims Of patients with atrial fibrillation (AF), approximately 10{\%} undergo percutaneous coronary intervention (PCI). We studied the safety and efficacy of dual vs. triple antithrombotic therapy (DAT vs. TAT) in this population. Methods and results A systematic review and meta-analysis was conducted using PubMed, Embase, EBSCO, Cochrane database of systematic reviews, Web of Science, and relevant meeting abstracts for Phase 3, randomized trials that compared DAT vs. TAT in patients with AF following PCI. Four trials including 5317 patients were included, of whom 3039 (57{\%}) received DAT. Compared with the TAT arm, Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding showed a reduction by 47{\%} in the DAT arm [4.3{\%} vs. 9.0{\%}; hazard ratio (HR) 0.53, 95{\%} credible interval (CrI) 0.36-0.85, I2 = 42.9{\%}]. In addition, there was no difference in the trial-defined major adverse cardiac events (MACE) (10.4{\%} vs. 10.0{\%}, HR 0.85, 95{\%} CrI 0.48-1.29, I2 = 58.4{\%}), or in individual outcomes of all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, or stroke between the two arms. Conclusion Compared with TAT, DAT shows a reduction in TIMI major or minor bleeding by 47{\%} with comparable outcomes of MACE. Our findings support the concept that DAT may be a better option than TAT in many patients with AF following PCI.",
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T1 - Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention

T2 - A systematic review and meta-analysis of randomized clinical trials

AU - Golwala, Harsh

AU - Cannon, Christopher P.

AU - Steg, Ph Gabriel

AU - Doros, Gheorghe

AU - Qamar, Arman

AU - Ellis, Stephen G.

AU - Oldgren, Jonas

AU - Ten Berg, Jurrien M.

AU - Kimura, Takeshi

AU - Hohnloser, Stefan H.

AU - Lip, Gregory Y.H.

AU - Bhatt, Deepak L.

PY - 2018/5/14

Y1 - 2018/5/14

N2 - Aims Of patients with atrial fibrillation (AF), approximately 10% undergo percutaneous coronary intervention (PCI). We studied the safety and efficacy of dual vs. triple antithrombotic therapy (DAT vs. TAT) in this population. Methods and results A systematic review and meta-analysis was conducted using PubMed, Embase, EBSCO, Cochrane database of systematic reviews, Web of Science, and relevant meeting abstracts for Phase 3, randomized trials that compared DAT vs. TAT in patients with AF following PCI. Four trials including 5317 patients were included, of whom 3039 (57%) received DAT. Compared with the TAT arm, Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding showed a reduction by 47% in the DAT arm [4.3% vs. 9.0%; hazard ratio (HR) 0.53, 95% credible interval (CrI) 0.36-0.85, I2 = 42.9%]. In addition, there was no difference in the trial-defined major adverse cardiac events (MACE) (10.4% vs. 10.0%, HR 0.85, 95% CrI 0.48-1.29, I2 = 58.4%), or in individual outcomes of all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, or stroke between the two arms. Conclusion Compared with TAT, DAT shows a reduction in TIMI major or minor bleeding by 47% with comparable outcomes of MACE. Our findings support the concept that DAT may be a better option than TAT in many patients with AF following PCI.

AB - Aims Of patients with atrial fibrillation (AF), approximately 10% undergo percutaneous coronary intervention (PCI). We studied the safety and efficacy of dual vs. triple antithrombotic therapy (DAT vs. TAT) in this population. Methods and results A systematic review and meta-analysis was conducted using PubMed, Embase, EBSCO, Cochrane database of systematic reviews, Web of Science, and relevant meeting abstracts for Phase 3, randomized trials that compared DAT vs. TAT in patients with AF following PCI. Four trials including 5317 patients were included, of whom 3039 (57%) received DAT. Compared with the TAT arm, Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding showed a reduction by 47% in the DAT arm [4.3% vs. 9.0%; hazard ratio (HR) 0.53, 95% credible interval (CrI) 0.36-0.85, I2 = 42.9%]. In addition, there was no difference in the trial-defined major adverse cardiac events (MACE) (10.4% vs. 10.0%, HR 0.85, 95% CrI 0.48-1.29, I2 = 58.4%), or in individual outcomes of all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, or stroke between the two arms. Conclusion Compared with TAT, DAT shows a reduction in TIMI major or minor bleeding by 47% with comparable outcomes of MACE. Our findings support the concept that DAT may be a better option than TAT in many patients with AF following PCI.

KW - Antithrombotic therapy

KW - Atrial fibrillation

KW - Dual therapy

KW - Percutaneous coronary intervention

KW - Triple therapy

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