Dual antithrombotic therapy reduced TIMI major or minor bleeding compared to triple therapy (4.3% vs. 9.0%; HR 0.53; 95% CrI 0.36-0.85) with comparable rates of major adverse cardiac events.
Meta-Analysis (n=5,317)
Does dual antithrombotic therapy reduce bleeding compared to triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention?
In patients with atrial fibrillation undergoing PCI, dual antithrombotic therapy significantly reduces bleeding risk without increasing major adverse cardiac events compared to triple antithrombotic therapy.
Effect estimate: HR 0.53 (95% CI 0.36-0.85)
Absolute Event Rate: 4.3% vs 9%
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.
Golwala et al. (Thu,) conducted a meta-analysis in Atrial fibrillation following percutaneous coronary intervention (n=5,317). Dual antithrombotic therapy (DAT) vs. Triple antithrombotic therapy (TAT) was evaluated on Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding (HR 0.53, 95% CI 0.36-0.85). Dual antithrombotic therapy reduced TIMI major or minor bleeding compared to triple therapy (4.3% vs. 9.0%; HR 0.53; 95% CrI 0.36-0.85) with comparable rates of major adverse cardiac events.