Meta-Analysis Comparing Dual Versus Single Antiplatelet Therapy in Combination With Antithrombotic Therapy in Patients With Atrial Fibrillation Who Underwent Percutaneous Coronary Intervention With Stent Implantation

The coexistence of atrial fibrillation and coronary artery disease is commonly found in clinical practice. The aim of this meta-analysis is to compare the clinical efficacy and safety of dual versus single antiplatelet therapy in combination with antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention. PubMed, EMBASE and Web of Science databases were systematically evaluated for articles published up to October 31, 2017. The risk ratios (RR) were extracted from each study. Pooled estimates with corresponding 95% confidence intervals (CI) were estimated by a fixed or random-effects model. Eight studies involving a total of 10,861 patients with atrial fibrillation were included in this meta-analysis. Five thousand sixty-six participants received dual antiplatelet therapy together with warfarin or new oral anticoagulation (triple antithrombotic therapy, TT) and 5,795 participants received single antiplatelet therapy together with warfarin or new oral anticoagulation (dual antithrombotic therapy). TT was associated with a significantly higher incidence of all (RR 1.45, p <0.001) and major (RR 1.77, p <0.001) bleeding events, but no difference with regard to stroke, in-stent thrombosis, major adverse cardiovascular events, and all-cause mortality rate. In conclusion, as compared to TT, dual antithrombotic therapy is equally effective in reducing stroke, in-stent thrombosis, major adverse cardiovascular events, and all-cause mortality rate, but shows beneficial effect in reducing overall bleeding incidence in atrial fibrillation patients who underwent percutaneous coronary intervention.