Dual compared with triple antithrombotics treatment effect on ischemia and bleeding in atrial fibrillation following percutaneous coronary intervention: A meta-analysis

Q: What are the key findings of this study?

Dual antithrombotic therapy significantly reduced major bleeding (OR 0.58, 95% CI 0.51-0.66, p<0.001) compared to triple antithrombotic therapy in AF patients after PCI without increasing mortality.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation undergoing percutaneous coronary intervention (n=8019). Intervention: Dual antithrombotic treatment (DATT) including a direct oral anticoagulant and a P2Y12 inhibitor vs. Triple antithrombotic treatment (TAT) comprising a vitamin K antagonist and dual antiplatelet therapy. Primary outcome: Major bleeding (OR 0.58, 95% CI 0.51-0.66, p=<0.001).

Q: What does this research mean for the field?

Dual antithrombotic therapy significantly reduces major bleeding compared to triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, without significantly increasing mortality or ischemic risks. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the safety and efficacy of dual antithrombotic therapy containing direct oral anticoagulants versus triple antithrombotic therapy with vitamin K antagonists in patients with atrial fibrillation undergoing percutaneous coronary intervention.

Marina Emad; Hasnaa Osama; Hoda Rabea; Haitham Saeed

doi:10.61466/ijcmr1020010

September 28, 2023International Journal of Clinical Medical ResearchOpen Access

Dual compared with triple antithrombotics treatment effect on ischemia and bleeding in atrial fibrillation following percutaneous coronary intervention: A meta-analysis

View Full Paper

Ask AI

Bookmark

Share

Key result

Dual therapy reduces major bleeding compared to triple therapy in post-PCI AF without increasing mortality.

OR 0.58
95% CI 0.51-0.66
P<0.001
n=8,019

Why the study?

To evaluate the effects of dual antithrombotic treatment including direct oral anticoagulants versus triple antithrombotic therapy with vitamin K antagonists on bleeding and ischemic outcomes in patients with AF after PCI.

Does dual antithrombotic therapy including a direct oral anticoagulant reduce bleeding without increasing ischemic events compared to triple antithrombotic therapy with a vitamin K antagonist in patients with atrial fibrillation following percutaneous coronary intervention?

Key Points

To evaluate the safety and efficacy of dual antithrombotic therapy containing direct oral anticoagulants versus triple antithrombotic therapy with vitamin K antagonists in patients with atrial fibrillation undergoing percutaneous coronary intervention.
Systematic literature search through April 2021 including 5 studies with 8019 subjects with atrial fibrillation receiving antithrombotic treatment following percutaneous coronary intervention (4325 receiving dual therapy and 3694 receiving triple therapy).
Calculated odds ratios (ORs) with 95% confidence intervals (CIs) using fixed- or random-effects models across bleeding and ischemic outcomes.
Dual antithrombotic therapy had significantly lower major bleeding (OR, 0.58; 95% CI, 0.51-0.66, p<0.001) and thrombolysis in myocardial infarction major and minor bleeding (OR, 0.49; 95% CI, 0.36-0.67, p<0.001) compared to triple antithrombotic therapy.
Dual antithrombotic therapy showed no significant difference compared to triple therapy in all-cause mortality (OR, 1.08; 95% CI, 0.88-1.33, p=0.46), cardiovascular mortality (OR, 1.07; 95% CI, 0.83-1.38, p=0.63), myocardial infarction (OR, 1.16; 95% CI, 0.92-1.46, p=0.01), stent thrombosis (OR, 1.42; 95% CI, 0.94-2.12, p=0.09), or stroke (OR, 0.86; 95% CI, 0.59-1.25, p=0.42).

Study Design

Type

Meta-Analysis (n=8,019)

Blinding

Open-label

Structured PICO

Does dual antithrombotic therapy including a direct oral anticoagulant reduce bleeding without increasing ischemic events compared to triple antithrombotic therapy with a vitamin K antagonist in patients with atrial fibrillation following percutaneous coronary intervention?

P

Population

8,019 patients across 5 trials with atrial fibrillation undergoing percutaneous coronary intervention receiving dual (n=4,325) or triple (n=3,694) antithrombotic therapy.

I

Intervention

Dual antithrombotic treatment (DATT) comprising a direct oral anticoagulant (DOAC: rivaroxaban, dabigatran, apixaban, or edoxaban) plus a P2Y12 inhibitor (predominantly clopidogrel)

C

Comparator

Triple antithrombotic treatment (TAT) comprising a vitamin K antagonist plus dual antiplatelet therapy (aspirin and a P2Y12 inhibitor)

O

Outcome

Major bleeding and Thrombolysis in Myocardial Infarction (TIMI) major and minor bleedingsafety

Main Result

Odds Ratio: 0.58 (95% CI 0.51–0.66)

p-value: p=<0.001

In patients with atrial fibrillation undergoing PCI, dual antithrombotic therapy with a DOAC and P2Y12 inhibitor halves the odds of major bleeding compared to vitamin K antagonist-based triple therapy without significantly increasing mortality, stroke, or stent thrombosis.

Limitations

Small number of included studies (5 trials)
Reliance on trial-level data prevented adjustment for DOAC type, P2Y12 inhibitor type, age, sex, ethnicity, or comorbidities
High heterogeneity in study protocols, such as time to randomization and duration of triple therapy
Lower than expected ischemic event rates resulting in restricted statistical power for ischemia and mortality
Included trials had open-label designs and excluded patients with renal dysfunction or high baseline bleeding risk
Small number of included studies (5 studies)
Inability to adjust for subject-level data, age, gender, ethnicity, direct oral anticoagulant type, or comorbid conditions due to reliance on trial-level data
Over 90% of participants used clopidogrel, precluding evaluation of other P2Y12 inhibitors
Restricted statistical power to identify significant differences in ischemia and mortality due to lower than expected ischemic event rates
Included randomized controlled trials had open-label designs and excluded patients with renal dysfunction

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Supports dual over triple antithrombotic therapy to reduce bleeding in AF after PCI; confirms ischemic safety in meta-analysis of trials.

Abstract

Background: We performed a meta-analysis to evaluate the effects of dual antithrombotic treatment (DATT) including direct oral anticoagulants (OAs) versus triple antithrombotic (TAT) with vitamin K antagonist on bleeding and ischemic results in atrial fibrillation (AF) after percutaneous coronary intervention. Methods: A systematic literature search up to April 2021 was done and 5 studies included 8019 subjects with AF using antithrombotic treatment after percutaneous coronary intervention at the start of the study; 4325 of them were using DATT and 3694 were using TATs. They were reporting relationships between the effects of DATT including direct OAs versus TAT with vitamin K antagonist on bleeding and ischemic results in AF after percutaneous coronary intervention. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effects of DATT including direct OAs versus TAT with vitamin K antagonist on bleeding and ischemic results in AF after percutaneous coronary intervention using the dichotomous method with a random or fixed-effect model. Results: Dual antithrombotics had significantly lower major bleeding (OR, 0.58; 95% CI, 0.51-0.66, p<0.001), and thrombolysis in myocardial infarction major and minor bleeding (OR, 0.49; 95% CI, 0.36-0.67, p<0.001) compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention. However, antithrombotics had no significantly difference in all-cause mortality (OR, 1.08; 95% CI, 0.88-1.33, p=0.46), cardiovascular mortality (OR, 1.07; 95% CI, 0.83-1.38, p=0.63), myocardial infarction (OR, 1.16; 95% CI, 0.92-1.46, p=0.01), stent thrombosis (OR, 1.42; 95% CI, 0.94-2.12., p=0.09), and stroke (OR, 0.86; 95% CI, 0.59-1.25, p=0.42) compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention. Conclusions: Dual antithrombotics may have a lower risk of major bleeding, and thrombolysis in myocardial infarction major and minor bleeding compared to TATs in subjects with AF using antithrombotic treatment after percutaneous coronary intervention. However, antithrombotics had no significant difference in all-cause mortality, cardiovascular mortality, myocardial infarction, stent thrombosis, and stroke compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention. Furthers studies are required to validate these findings.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Emad et al. (2023) conducted a meta-analysis in Atrial fibrillation undergoing percutaneous coronary intervention (n=8,019). Dual antithrombotic treatment (DATT) including a direct oral anticoagulant and a P2Y12 inhibitor vs. Triple antithrombotic treatment (TAT) comprising a vitamin K antagonist and dual antiplatelet therapy was evaluated on Major bleeding (OR 0.58, 95% CI 0.51-0.66, p=<0.001). Dual antithrombotic therapy significantly reduced major bleeding (OR 0.58, 95% CI 0.51-0.66, p<0.001) compared to triple antithrombotic therapy in AF patients after PCI without increasing mortality.

synapsesocial.com/papers/6a774327e539f649abf6e723 https://doi.org/10.61466/ijcmr1020010

View Full Paper

Ask AI

Bookmark

Share

Dual compared with triple antithrombotics treatment effect on ischemia and bleeding in atrial fibrillation following percutaneous coronary intervention: A meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Dual compared with triple antithrombotics treatment effect on ischemia and bleeding in atrial fibrillation following percutaneous coronary intervention: A meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading