Key result
In real-world patients with ACS on OAC after PCI, triple therapy did not increase adverse outcomes compared to dual therapy and decreased the risk of re-infarction.
Why the study?
Does triple antithrombotic therapy improve outcomes compared to dual therapy in patients with ACS undergoing PCI who require oral anticoagulation?
Observational (n=15,401)
Does triple antithrombotic therapy improve outcomes compared to dual therapy in patients with ACS undergoing PCI who require oral anticoagulation?
Hazard Ratio: 2.333 (95% CI 1.078–5.047)
In real-world patients with ACS undergoing PCI who require oral anticoagulation, triple antithrombotic therapy may decrease the risk of re-infarction without increasing severe bleeding compared to dual therapy.
Real-world OAC regimens post-ACS/PCI warrant cautious interpretation; leaves open optimal strategy pending randomized trials.
OBJECTIVE: The optimal antithrombotic regimen for patients on oral anticoagulation (OAC) after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI) remains debated. This study sought to evaluate the efficacy and safety of OAC plus clopidogrel with or without aspirin in a real-world setting. METHODS: = 15,401). Patients with ACS and receiving OAC after PCI were screened. The composite primary endpoint was 1-year all-cause death, re-infarction, or severe bleeding. RESULTS: 5.34%; unadjusted HR: 2.807; 95% CI: 1.329-5.928; adjusted HR: 2.333; 95% CI: 1.078-5.047). In addition, there was no difference between two regimes in all-cause death and severe bleeding. CONCLUSIONS: In real-life patients with ACS following PCI and with an indication of OAC, triple therapy was not associated with an increased rate of adverse outcomes compared to dual therapy. Moreover, it decreased risk of re-infarction and did not increase risk of severe bleeding.
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Yan et al. (2017) conducted an observational in Acute coronary syndrome requiring oral anticoagulation after PCI (n=15,401). Triple therapy (OAC plus clopidogrel and aspirin) vs. Dual therapy (OAC plus clopidogrel without aspirin) was evaluated on 1-year all-cause death, re-infarction, or severe bleeding (adjusted HR 2.333, 95% CI 1.078-5.047). In real-world patients with ACS on OAC after PCI, triple therapy did not increase adverse outcomes compared to dual therapy and decreased the risk of re-infarction.
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