Key result
New oral anticoagulants combined with antiplatelet drugs reduced the incidence of major adverse cardiovascular events by 16% compared to antiplatelet drugs alone in patients with coronary heart disease (OR 0.84), but significantly increased the risk of major and minor bleeding.
Why the study?
To evaluate the efficacy and safety of new oral anticoagulants combined with antiplatelet drugs in patients with coronary atherosclerotic heart disease.
Does NOAC combined with antiplatelet drugs reduce MACE in patients with CAD?
Meta-Analysis (n=43,650)
Yes
Does NOAC combined with antiplatelet drugs reduce MACE in patients with CAD?
Adding NOACs to antiplatelet therapy in CAD patients reduces MACE, myocardial infarction, and mortality, but significantly increases the risk of major and minor bleeding.
Supports NOAC addition to antiplatelets for MACE reduction; confirms benefit in Level 1 meta-analysis of randomized data.
OBJECTIVE: To analyze the efficacy and safety of antiplatelet drugs combined with new oral anticoagulants (noac) in the treatment of coronary atherosclerotic heart disease (CAD). METHODS: The randomized controlled trials of noac combined with antiplatelet therapy in Cochrane, CNKI, PubMed, EMBASE, Wanfang, Google Scholar, and Baidu library were searched using the literature database. Two researchers independently searched and screened to ensure the consistency of the results, and the literature was summarized and analyzed by Revman 5.3 software. RESULTS: Five research results were included. The results showed that the incidence of mace [95% CI 0.75-0.95, or = 0.84,p = .04], the incidence of major and minor bleeding [95% CI 1.25-5.16, or = 2.54,p = .01], the mortality of cardiovascular disease [95% CI 0.78-0.96, or = 0.86, p = .05], the total mortality [95% CI 0.79-0.95, or = 0.87, p = .003], and the incidence of myocardial infarction in patients with CAD treated with noac and antiplatelet drugs [95% CI 0.77-0.95, or = 0.85, p = .004] was lower than that treated with antiplatelet drugs alone, and the difference was statistically significant (p < .05); the incidence of fatal bleeding [95% CI 0.81-2.08, or = 1.30, p = .28], the incidence of stroke [95% CI 0.50-1.03, or = 0.71, p = .07], and the incidence of intracranial hemorrhage [95% CI 1.02-2.56, or = 1.61, p = .06]. There was no significant difference with antiplatelet drugs alone (p > .05). CONCLUSION: Noac combined with antiplatelet drugs can reduce mace, total mortality, the incidence of myocardial infarction, and cardiovascular mortality in patients with CAD, but may increase the risk of bleeding.
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Saiyitijiang et al. (2022) conducted a meta-analysis in Coronary atherosclerotic heart disease (CAD) (n=43,650). New oral anticoagulants (NOACs) combined with antiplatelet drugs vs. Antiplatelet drugs alone was evaluated on Major adverse cardiovascular events (MACE) (OR 0.84, 95% CI 0.75-0.95, p=0.04). New oral anticoagulants combined with antiplatelet drugs reduced the incidence of major adverse cardiovascular events by 16% compared to antiplatelet drugs alone in patients with coronary heart disease (OR 0.84), but significantly increased the risk of major and minor bleeding.
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