Is triple antithrombotic therapy a safe option in patients with AF who receive drug-eluting stents?: a review article

Figures

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  Fig. 1. Evidence collated during the process of NOACs inclusion into the 21st WHO Model List of Essential Medicines: this table shows data from RCTs and reporting real world data (RWD) about the efficacy of NOACs versus warfarin in reducing stroke in non-valvular AF patients. NOACs were associated with either similar or superior outcomes at preventing stroke event. DOI: http://doi.org/10.5334/gh.608

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  Fig. 2. Evidence collated during the process of NOACs inclusion into the 21st WHO Model List of Essential Medicines: this table shows the risks of major bleeding in non-valvular AF patients treated by NOACs versus warfarin in non-valvular AF patients. As overall NOACs had lower major bleeding and intracranial hemorrhage (ICH) in comparison with warfarin. DOI: http://doi.org/10.5334/gh.608

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  Fig. 3. Stent Thrombosis in Patients With Atrial Fibrillation Undergoing Coronary Stenting in the AUGUSTUS Trial (2020): As seen in this figure that the incidence of stent thrombosis is largely confined to the first 30 days after stent implantation [26]. 10.1161/CIRCULATIONAHA.119.044584

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  Fig. 4. Triple therapy: A review of antithrombotic treatment for patients with atrial fibrillation undergoing percutaneous coronary intervention; this diagram shows the history of guidelines and how the use of TAT is becoming less endorsed [28]. DOI: 10.1016/j.jjcc.2018.09.001

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  Fig. 5. WOEST trial (2013): Primary outcomes of any bleeding, Significant high bleeding in the TAT group compared to DAT [21]. DOI: 10.1016/S0140-6736(12)62177-1

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  Fig. 6. PIONEER AF-PCI (2016) trial: Primary outcomes of major bleeding, Significant high bleeding rates in the TAT group compared to DAT. Group 1 = rivaroxaban 10–15 mg daily + P2Y12 inhibitor, Group 2 = Riva. 2.5 mg BID + DAP, Group 3 = VKA + DAPT [33]. 10.1056/NEJMoa1611594

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  Fig. 7. RE-DUAL PCI (2017) trial: Primary outcomes of major bleeding were significantly high bleeding in the TAT group compared to both DAT (dabi. 110 and 150 mg). dabi. 110 mg had a better safety profile (lower bleeding) than TAT and DAT (dabi. 150 mg) [23]. 10.1056/NEJMoa1708454

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  Fig. 8. ENTRUST-AF-PCI (2019) trial: Primary outcomes of major bleeding were significantly high in the TAT group compared to both DAT (edoxapan 60 mg). dabi. *failed to show any superiority but only non-inferiority [24]. DOI: 10.1016/S0140-6736(19)31872-0

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  Fig. 9. AUGUSTUS trial (2019): Primary outcomes of major/clinically relevant bleeding, showing significant high bleeding in the TAT group compared to DAT. *Note: all patients received P2Y12 inhibitor besides the given medications [25]. 10.1056/NEJMoa1817083