Key result
Dual antiplatelet therapy significantly reduced the 30-day risk of death, myocardial infarction, and revascularization compared to OAC and aspirin (RR 0.41; 95% CI 0.25-0.69).
Why the study?
Does oral anticoagulation and aspirin compared to dual antiplatelet therapy affect the risk of cardiac events and hemorrhagic/vascular complications in patients after coronary stenting?
Meta-Analysis (n=2,436)
Does oral anticoagulation and aspirin compared to dual antiplatelet therapy affect the risk of cardiac events and hemorrhagic/vascular complications in patients after coronary stenting?
Effect estimate: RR 0.41 (95% CI 0.25-0.69)
Although dual antiplatelet therapy is more effective at reducing 30-day ischemic events, the absolute risk of adverse events with OAC plus aspirin is low, making it an acceptable regimen for post-PCI patients with a mandatory indication for long-term anticoagulation.
DAPT lowers 30-day ischemic events versus OAC plus aspirin post-stenting; confirms randomized evidence favoring dual antiplatelet regimens.
The combination of oral anticoagulation (OAC) and aspirin was the antithrombotic treatment initially adopted after coronary stenting (PCI-S). Although dual antiplatelet therapy with aspirin and a thienopyridine subsequently proved safer and more effective, OAC and aspirin combination is still used in patients with an indication for long-term OAC undergoing PCI-S. The absolute (AR) and relative (RR) risk of cardiac events and hemorrhagic/vascular complications of OAC and aspirin versus antiplatelet therapy were evaluated in a meta-analysis of four historical clinical trials. In 2,436 patients, the RR of a 30-day primary composite endpoint of death, myocardial infarction and the need for revascularization was significantly reduced by antiplatelet therapy (RR 0.41; 95% CI 0.25-0.69), whereas the RR of stent thrombosis (RR 0.26; 95% CI 0.06-1.14) and major bleeding (RR 0.36; 95% CI 0.14-1.02) was not statistically different. The 30-day AR of death, myocardial infarction, need for revascularization, major bleedings and vascular complications with OAC and aspirin were 0.65, 3.8, 4.2, 6.4 and 6.6%, respectively. In conclusion, due to the low AR of adverse events, the combination of OAC and aspirin appears an acceptable treatment after PCI-S in patients in whom long-term OAC is deemed mandatory.
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Rubboli et al. (2005) conducted a meta-analysis in Coronary stenting (PCI-S) (n=2,436). Oral anticoagulation (OAC) and aspirin vs. Dual antiplatelet therapy was evaluated on 30-day primary composite endpoint of death, myocardial infarction and the need for revascularization (RR 0.41, 95% CI 0.25-0.69). Dual antiplatelet therapy significantly reduced the 30-day risk of death, myocardial infarction, and revascularization compared to OAC and aspirin (RR 0.41; 95% CI 0.25-0.69).
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