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Title: | Safety and Efficacy of Double Antithrombotic Therapy With Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis | Authors: | Capodanno, Davide Di Maio, Marco Greco, Antonio Bhatt, Deepak L. Gibson, C. Michael Goette, Andreas Lopes, Renato D. Mehran, Roxana VRANCKX, Pascal Angiolillo, Dominick J. |
Issue Date: | 2020 | Publisher: | WILEY | Source: | JOURNAL OF THE AMERICAN HEART ASSOCIATION, 9 (16) (Art N° e017212) | Abstract: | Background The optimal antithrombotic therapy for patients with atrial fibrillation undergoing percutaneous coronary intervention is a topic of debate. We aimed at defining the efficacy and safety of double antithrombotic therapy with single antiplatelet therapy (SAPT) plus a non-vitamin K antagonist oral anticoagulant (NOAC) against triple antithrombotic therapy with dual antiplatelet therapy (DAPT) added to a vitamin K antagonist (VKA), illustrating the pooled cumulative distribution of events, the ranking of different NOACs tested in NOAC+SAPT combination strategies, and the state of the current evidence in the field. Methods and Results Randomized controlled trials meeting the inclusion criteria were identified. The primary efficacy end point was the composite of trial-defined major adverse cardiac events. The primary safety end point was clinically significant bleeding. Secondary end points were the components of primary end points. Trial-level pairwise and Bayesian network meta-analyses, reconstructed Kaplan-Meier analyses, and trial sequential analysis were performed. Four randomized controlled trials (10 969 patients) were included. No differences were found in terms of major adverse cardiac events (hazard ratio [HR], 1.07; 95% CI, 0.94-1.22), and the NOAC+SAPT strategy showed a lower rate of clinically significant bleeding compared with VKA + DAPT (HR, 0.56; 95% CI, 0.39-0.80). These results were consistent in reconstructed Kaplan-Meier analyses. In the Bayesian network meta-analysis, different NOACs displayed diverse risk-benefit profiles. Trial sequential analyses suggest that the evidence for the similarity in major adverse cardiac events compared with VKA + DAPT and the bleeding risk reduction observed with NOAC+SAPT is likely to be conclusive. Conclusions NOAC+SAPT does not increase the risk of major adverse cardiac events and reduces the risk of bleeding compared with VKA + DAPT in AF patients undergoing percutaneous coronary intervention. Various NOACs may have different risk-benefit profiles in combination strategies. Registration URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020151089. | Notes: | Angiolillo, DJ (corresponding author), Univ Florida, Coll Med Jacksonville, 655 West 8th St, Jacksonville, FL 32209 USA. dominick.angiolillo@jax.ufl.edu |
Other: | Angiolillo, DJ (corresponding author), Univ Florida, Coll Med Jacksonville, 655 West 8th St, Jacksonville, FL 32209 USA. dominick.angiolillo@jax.ufl.edu | Keywords: | acute coronary syndrome;anticoagulant therapy;antiplatelet therapy;antithrombotic therapy;atrial fibrillation;percutaneous coronary intervention | Document URI: | http://hdl.handle.net/1942/32990 | ISSN: | 2047-9980 | e-ISSN: | 2047-9980 | DOI: | 10.1161/JAHA.120.017212 | ISI #: | WOS:000574868200014 | Rights: | 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. JAHA is available at: www.ahajournals.org/journal/jaha | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2021 |
Appears in Collections: | Research publications |
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File | Description | Size | Format | |
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JAHA.120.017212.pdf | Published version | 3.73 MB | Adobe PDF | View/Open |
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