Key result
Triple therapy was associated with an increased risk of major bleeding compared with DAPT (RR 1.96; 95% CI 1.40-2.74) and DT (RR 1.65; 95% CI 1.23-2.21), with no thromboembolic benefit.
Why the study?
Does triple therapy improve efficacy or increase bleeding compared to dual therapy in patients with atrial fibrillation and ischemic heart disease?
Meta-Analysis
Does triple therapy improve efficacy or increase bleeding compared to dual therapy in patients with atrial fibrillation and ischemic heart disease?
Relative Risk: 1.96 (95% CI 1.4–2.74)
In patients with atrial fibrillation and ischemic heart disease, triple therapy increases the risk of major bleeding without providing additional thromboembolic protection compared to dual therapy.
May favor dual over triple therapy to reduce bleeding in AF with IHD; leaves open confirmation by RCTs.
// Wengen Zhu 1, * , Linjuan Guo 1, * , Fadi Liu 1, * , Rong Wan 2 , Yang Shen 2 , Gregory Y.H. Lip 3, # and Kui Hong 1, 2, # 1 Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China 2 Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, China 3 University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom * These authors share co-first authorship # These authors share co-senior authorship Correspondence to: Kui Hong, email: hongkui88@163.com Keywords: atrial fibrillation, ischemic heart disease, triple therapy, dual therapy Received: April 11, 2017 Accepted: August 26, 2017 Published: September 14, 2017 ABSTRACT The optimal antithrombotic regimen for patients with atrial fibrillation and ischemic heart disease remains unclear. Therefore, we aimed to compare the efficacy and safety of triple therapy (TT [an anticoagulant and 2 antiplatelet drugs]) with dual therapy (DAPT [2 antiplatelet drugs] or DT [an anticoagulant and a single antiplatelet drug]) in patients with atrial fibrillation and ischemic heart disease. We systematically searched the Cochrane Library, PubMed and Embase databases for all relevant studies up to August 2017. The overall risk estimates were calculated using the random-effects model. A total of 17 observational studies were included. Regarding the efficacy outcomes, no differences were observed between the triple therapy and the dual therapy for all-cause death, cardiovascular death, or thrombotic complications (i.e., acute coronary syndrome, stent thrombosis, thromboembolism/stroke, and major adverse cardiac and cerebrovascular events). Regarding the safety outcomes, compared with DAPT, TT was associated with increased risks of major bleeding (a relative risk of 1.96 [1.40–2.74]), minor bleeding (1.69 [1.06–2.71]) and overall bleeding (1.80 [1.23–2.64]). Compared wtih DT, TT was associated with a greater risk of major bleeding (1.65 [1.23–2.21]), but rates of minor bleeding (0.99 [0.56–1.77]) and overall bleeding (1.14 [0.76–1.71]) were similar. Overall, TT confers an increased hazard of major bleeding with no thromboembolic protection compared with dual therapy in patients with atrial fibrillation and ischemic heart disease.
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Zhu et al. (2017) conducted a meta-analysis in Atrial fibrillation and ischemic heart disease. Triple therapy (anticoagulant and 2 antiplatelet drugs) vs. Dual therapy (DAPT or DT) was evaluated on Major bleeding (compared with DAPT) (RR 1.96, 95% CI 1.40-2.74). Triple therapy was associated with an increased risk of major bleeding compared with DAPT (RR 1.96; 95% CI 1.40-2.74) and DT (RR 1.65; 95% CI 1.23-2.21), with no thromboembolic benefit.
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