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Title: | Safety and efficacy outcomes of double vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulant-based randomized clinical trials | Authors: | Gargiulo, Giuseppe Goette, Andreas Tijssen, Jan Eckardt, Lars Lewalter, Thorsten VRANCKX, Pascal Valgimigli, Marco |
Issue Date: | 2019 | Publisher: | OXFORD UNIV PRESS | Source: | EUROPEAN HEART JOURNAL, 40 (46) , p. 3757 -3767 | Abstract: | Aims To investigate the safety and efficacy of double vs. triple antithrombotic therapy (DAT vs. TAT) in patients with atrial fibrillation (AF) and acute coronary syndrome or who underwent percutaneous coronary intervention (PCI). Methods and results A systematic review and meta-analysis was performed using PubMed to search for non-vitamin K antagonist oral anticoagulant (NOAC)-based randomized clinical trials comparing DAT vs. TAT in AF patients undergoing PCI. Four trials encompassing 10 234 patients (DAT = 5496 vs. TAT = 4738) were included. The primary safety endpoint (ISTH major or clinically relevant non-major bleeding) was significantly lower with DAT compared with TAT [risk ratio (RR) 0.66, 95% confidence interval (CI) 0.56-0.78; P<0.0001; I-2 = 69%], which was consistent across all available bleeding definitions. This benefit was counterbalanced by a significant increase of stent thrombosis (RR 1.59, 95% CI 1.01-2.50; P = 0.04; I-2 = 0%) and a trend towards higher risk of myocardial infarction with DAT. There were no significant differences in all-cause and cardiovascular death, stroke and major adverse cardiovascular events. The comparison of NOAC-based DAT vs. vitamin K antagonist (VKA)-TAT yielded consistent results and a significant reduction of intracranial haemorrhage (RR 0.33, 95% CI 0.17-0.65; P = 0.001; I-2 = 0%). Conclusion Double antithrombotic therapy, particularly if consisting of a NOAC instead of VKA and a P2Y12 inhibitor, is associated with a reduction of bleeding, including major and intracranial haemorrhages. This benefit is however counterbalanced by a higher risk of cardiac-mainly stent-related-but not cerebrovascular ischaemic occurrences. | Notes: | Valgimigli, M (reprint author), Univ Bern, Dept Cardiol, Inselspital, Bern Univ Hosp, Freiburgstr 10, CH-3010 Bern, Switzerland. Marco.valgimigli@insel.ch |
Other: | Valgimigli, M (reprint author), Univ Bern, Dept Cardiol, Inselspital, Bern Univ Hosp, Freiburgstr 10, CH-3010 Bern, Switzerland. Marco.valgimigli@insel.ch | Keywords: | Atrial fibrillation;Percutaneous coronary intervention;Antithrombotic therapy;Double therapy;Triple therapy;Non-vitamin K antagonist oral anticoagulant | Document URI: | http://hdl.handle.net/1942/30614 | ISSN: | 0195-668X | e-ISSN: | 1522-9645 | DOI: | 10.1093/eurheartj/ehz732 | ISI #: | WOS:000506802900011 | Rights: | The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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giuseppe.pdf | Published version | 1.43 MB | Adobe PDF | View/Open |
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