Key result
Dual antithrombotic therapy decreased bleeding risk compared with triple therapy (HR 0.61; 95% CI 0.51-0.71; P<0.001) with similar major adverse cardiovascular event risk (HR 1.08; 95% CI 0.89-1.31).
Why the study?
The optimal antithrombotic regimen for patients with acute coronary syndrome and concomitant atrial fibrillation undergoing percutaneous coronary intervention is largely under investigation.
Does dual antithrombotic therapy reduce bleeding risk or major adverse cardiovascular events compared to triple antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome undergoing percutaneous coronary intervention?
Meta-Analysis (n=4,733)
Does dual antithrombotic therapy reduce bleeding risk or major adverse cardiovascular events compared to triple antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome undergoing percutaneous coronary intervention?
Hazard Ratio: 1.08 (95% CI 0.89–1.31)
p-value: p=0.44
In patients with atrial fibrillation and acute coronary syndrome undergoing PCI, dual antithrombotic therapy reduces bleeding risk without significantly increasing major adverse cardiovascular events compared to triple therapy.
Dual antithrombotic therapy shows no MACE increase versus triple; reinforces dual regimens to reduce bleeding without ischemic compromise.
BACKGROUND: The optimal antithrombotic regimen for patients undergoing percutaneous coronary intervention in acute coronary syndrome with concomitant atrial fibrillation is largely under investigation. METHOD: PUBMED and EMBASE were searched through October 2019 for randomized trials or subgroup analyses of randomized trials investigating different antithrombotic strategies in patients with atrial fibrillation and acute coronary syndrome undergoing percutaneous coronary intervention. We compared dual antithrombotic therapy versus triple antithrombotic therapy. Dual antithrombotic therapy was defined as vitamin K antagonist or direct oral anticoagulant plus P2Y12 inhibitor. Triple antithrombotic therapy was defined as vitamin K antagonist or direct oral anticoagulant plus dual antiplatelet therapy (aspirin plus P2Y12 inhibitor). The primary safety outcome was trial outcome was trial defined major adverse cardiovascular events. RESULTS: Our search identified 5 eligible subgroup analyses of randomized controlled trials that enrolled a total of 4733 patients. Dual antithrombotic therapy significantly decreased the bleeding risk when compared with triple antithrombotic therapy (hazard ratio: 0.61; 95% confidential interval [0.51-0.71], P < 0.001, I = 31%). However, there were no significant differences in major adverse cardiovascular event between dual antithrombotic therapy versus triple antithrombotic therapy (hazard ratio: 1.08; 95% confidential interval: 0.89-1.31, P = 0.44, I = 0%). CONCLUSION: In patients with atrial fibrillation and acute coronary syndrome undergoing percutaneous coronary intervention, dual antithrombotic therapy was associated with lower bleeding risk compared with triple antithrombotic therapy while conferring similar major adverse cardiovascular event risk. Our results should be interpreted cautiously because we did not analyze the risk of stent thrombosis.
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Kuno et al. (2020) conducted a meta-analysis in Atrial fibrillation and acute coronary syndrome undergoing percutaneous coronary intervention (n=4,733). Dual antithrombotic therapy vs. Triple antithrombotic therapy was evaluated on Trial defined major adverse cardiovascular events (HR 1.08, 95% CI 0.89-1.31, p=0.44). Dual antithrombotic therapy decreased bleeding risk compared with triple therapy (HR 0.61; 95% CI 0.51-0.71; P<0.001) with similar major adverse cardiovascular event risk (HR 1.08; 95% CI 0.89-1.31).
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