Key result
Triple antithrombotic therapy was associated with worse 2-year net clinical outcomes than dual antiplatelet therapy (34.3% vs 21.1%; OR 1.63, 95% CI 1.06-2.50), driven by increased major bleeding.
Why the study?
Does triple antithrombotic therapy compared to dual antiplatelet therapy improve net clinical outcomes in patients with atrial fibrillation undergoing drug-eluting stent implantation?
Cohort (n=367)
Does triple antithrombotic therapy compared to dual antiplatelet therapy improve net clinical outcomes in patients with atrial fibrillation undergoing drug-eluting stent implantation?
Odds Ratio: 1.63 (95% CI 1.06–2.5)
Absolute Event Rate: 34.3% vs 21.1%
p-value: p=0.006
Prolonged triple antithrombotic therapy in AF patients undergoing DES implantation increases the risk of major bleeding without reducing MACCE compared to dual antiplatelet therapy.
Triple therapy was associated with worse outcomes in this AF-DES cohort; leaves open whether RCTs will confirm net harm versus DAPT.
BACKGROUND: The optimal antithrombotic regimen in patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation for complex coronary artery disease is unclear. We compared the net clinical outcomes of triple antithrombotic therapy (TAT; aspirin, thienopyridine, and warfarin) and dual antiplatelet therapy (DAPT; aspirin and thienopyridine) in AF patients who had undergone DES implantation. METHODS: A total of 367 patients were enrolled and analyzed retrospectively; 131 patients (35.7%) received TAT and 236 patients (64.3%) received DAPT. DAPT and warfarin were maintained for a minimum of 12 and 24 months, respectively. The primary endpoint was the 2-year net clinical outcomes, a composite of major bleeding and major adverse cardiac and cerebral events (MACCE). Propensity score-matching analysis was carried out in 99 patient pairs. RESULTS: The 2-year net clinical outcomes of the TAT group were worse than those of the DAPT group (34.3 vs. 21.1%, P=0.006), which was mainly due to the higher incidence of major bleeding (16.7 vs. 4.6%, P<0.001), without any significant increase in MACCE (22.1 vs. 17.7%, P=0.313). In the multivariate analysis, TAT was an independent predictor of worse net clinical outcomes (odds ratio 1.63, 95% confidence interval 1.06-2.50) and major bleeding (odds ratio 3.54, 95% confidence interval 1.65-7.58). After propensity score matching, the TAT group still had worse net clinical outcomes and a higher incidence of major bleeding compared with the DAPT group. CONCLUSION: In AF patients undergoing DES implantation, prolonged administration of TAT may be harmful due to the substantial increase in the risk for major bleeding without any reduction in MACCE.
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Kang et al. (2015) conducted a cohort in Atrial fibrillation undergoing drug-eluting stent implantation (n=367). Triple antithrombotic therapy vs. Dual antiplatelet therapy was evaluated on 2-year net clinical outcomes, a composite of major bleeding and major adverse cardiac and cerebral events (MACCE) (OR 1.63, 95% CI 1.06-2.50, p=0.006). Triple antithrombotic therapy was associated with worse 2-year net clinical outcomes than dual antiplatelet therapy (34.3% vs 21.1%; OR 1.63, 95% CI 1.06-2.50), driven by increased major bleeding.
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