Key result
Dual antithrombotic therapy and DOACs reduce bleeding versus triple therapy and VKA post-PCI without ischemic concerns.
Why the study?
Combining anticoagulant and antiplatelet agents after PCI in AF patients balances ischemic and thromboembolic risk against bleeding, prompting a review of guidelines, trials, meta-analyses, and observational studies comparing antithrombotic regimens.
Does dual-antithrombotic therapy with DOACs reduce bleeding events compared to triple-antithrombotic therapy with VKAs in patients with atrial fibrillation undergoing PCI for acute coronary syndromes?
Does dual-antithrombotic therapy with DOACs reduce bleeding events compared to triple-antithrombotic therapy with VKAs in patients with atrial fibrillation undergoing PCI for acute coronary syndromes?
In patients with atrial fibrillation undergoing PCI for acute coronary syndromes, dual antithrombotic therapy with a DOAC reduces bleeding risk compared to triple therapy with a VKA, though there may be a slight increase in stent thrombosis risk.
Supports dual DOAC regimens to reduce bleeding post-PCI in AF; leaves stent thrombosis risk unresolved for prospective trials.
Patients with atrial fibrillation (AF) are at increased risk for coronary artery disease (CAD). After percutaneous coronary intervention (PCI), the antithrombotic therapy consists of a combination of anticoagulant and antiplatelet agents to reduce the ischemic and thromboembolic risk, at the cost of increased bleeding events. In the past few years, several randomized clinical trials involving over 12,000 patients have been conducted to compare the safety of vitamin K antagonist (VKA) and direct-acting oral anticoagulants (DOACs) in association with a single- or double-antiplatelet agent, in the so-called dual- (DAT) or triple-antithrombotic therapy (TAT). These studies and several meta-analyses showed a consistent benefit for reducing bleeding events of DAT over TAT and of DOAC over VKA, without concerns about ischemic endpoints, except for a trend for increased stent thrombosis risk. The present paper examines current international guidelines' recommendations and reviews clinical trials, meta-analyses, and observational studies conducted on AF patients treated with DAT or TAT after PCI for acute coronary syndromes.
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Luca et al. (2022) conducted a review in Atrial fibrillation and acute coronary syndromes undergoing PCI (n=12,000). Dual antithrombotic therapy (DAT) and DOACs vs. Triple antithrombotic therapy (TAT) and VKA was evaluated on Bleeding events and ischemic endpoints. Dual antithrombotic therapy and DOACs consistently reduced bleeding events compared to triple therapy and VKA in AF patients after PCI, with no ischemic concerns except a stent thrombosis trend.
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