Key result
Ticagrelor plus OAC is linked to higher bleeding rates versus clopidogrel in AF and CAD.
Why the study?
The safety and efficacy of ticagrelor versus other P2Y12 inhibitors combined with oral anticoagulants as part of DAPT/SAPT in patients with AF and CAD/PCI remained to be assessed.
Does ticagrelor compared to other P2Y12 inhibitors increase bleeding or reduce MACE in patients with atrial fibrillation and coronary artery disease receiving oral anticoagulants?
Meta-Analysis
Does ticagrelor compared to other P2Y12 inhibitors increase bleeding or reduce MACE in patients with atrial fibrillation and coronary artery disease receiving oral anticoagulants?
In patients with atrial fibrillation and coronary artery disease receiving oral anticoagulants, the use of ticagrelor instead of clopidogrel is associated with increased bleeding risk without a significant reduction in major adverse cardiovascular events.
Supports preferring clopidogrel over ticagrelor with oral anticoagulants in AF and CAD; confirms higher bleeding without MACE reduction in meta-analysis of RCTs.
Objective: We performed a meta-analysis of randomized controlled trials to assess the safety and efficacy of ticagrelor or other P2Y12 inhibitors in combination with oral anticoagulants as a part of DAPT/SAPT for the patients with atrial fibrillation (AF) and acute coronary disease (ACS) or undergoing percutaneous coronary intervention (PCI). Methods: We searched PubMed, Web of Science and ClinicalTrials.gov for randomized controlled trials (published from January 1, 1998, up to June 6, 2023; no language restrictions) comparing safety and efficacy of ticagrelor and DOACs or VKAs combination treatment arm with or without aspirin to other P2Y12 inhibitors treatment strategies. Main endpoints were clinically relevant bleeding as safety outcomes, all-cause mortality, and major adverse cardiovascular events (MACE) as efficacy outcomes. Conclusion: The use of ticagrelor is associated with significantly higher rates of bleeding when compared with clopidogrel in patients with concomitant atrial fibrillation and coronary artery disease.
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Li et al. (2025) conducted a meta-analysis in Atrial fibrillation and coronary artery disease. Ticagrelor plus oral anticoagulants (DOACs or VKAs) with or without aspirin vs. Other P2Y12 inhibitors (clopidogrel) was evaluated on Clinically relevant bleeding, all-cause mortality, and major adverse cardiovascular events (MACE). Ticagrelor combined with oral anticoagulants was associated with significantly higher bleeding rates compared to clopidogrel in patients with atrial fibrillation and coronary artery disease.
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