Why the study?
The optimal antithrombotic therapy for patients with atrial fibrillation undergoing percutaneous coronary intervention remained a topic of debate.
Does double antithrombotic therapy with NOAC and SAPT reduce bleeding and prevent major adverse cardiac events compared to triple therapy with VKA and DAPT in patients with atrial fibrillation undergoing PCI?
Meta-Analysis (n=10,969)
Does double antithrombotic therapy with NOAC and SAPT reduce bleeding and prevent major adverse cardiac events compared to triple therapy with VKA and DAPT in patients with atrial fibrillation undergoing PCI?
Answers are grounded in this paper and cite their sources.
In patients with atrial fibrillation undergoing PCI, double therapy with a NOAC and single antiplatelet therapy significantly reduces bleeding risk without increasing major adverse cardiac events compared to triple therapy with a VKA and dual antiplatelet therapy.
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.
No takes yet. Share an insight, caveat, or question.
Capodanno et al. (2020) conducted a meta-analysis in Atrial fibrillation undergoing percutaneous coronary intervention (n=10,969). Non-vitamin K antagonist oral anticoagulant (NOAC) plus single antiplatelet therapy (SAPT) vs. Vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT) was evaluated on Composite of trial-defined major adverse cardiac events (HR 1.07, 95% CI 0.94-1.22).
Synapse has enriched 10 related papers. Consider them for comparative context: