Antiplatelet therapy in patients with atrial fibrillation: a systematic review and meta-analysis of randomized trials
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Why the study?
The study aimed to systematically evaluate the effects of antiplatelet therapy on clinical outcomes in patients with AF, stratified by oral anticoagulation use.
Does antiplatelet therapy reduce stroke or affect bleeding in patients with atrial fibrillation, with or without background oral anticoagulation?
Comparison
Antiplatelet therapy vs control
Design
Systematic review and meta-analysis of randomized trials
Authors
Discussion
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Implication
Antiplatelets may be considered for stroke prevention in AF without anticoagulation but increase bleeding; reinforces avoiding combination therapy.
Structured PICO
Does antiplatelet therapy reduce stroke or affect bleeding in patients with atrial fibrillation, with or without background oral anticoagulation?
P
Population
21,518 patients with atrial fibrillation (AF) from 18 randomized trials, including those treated and not-treated with background oral anticoagulation.
I
Intervention
Antiplatelet therapy (aspirin or a P2Y12 inhibitor such as clopidogrel, ticagrelor, or prasugrel) administered orally at any dose and frequency for a minimum of 12 weeks.
C
Comparator
Control (either placebo or no direct comparator) receiving the same concomitant antithrombotic regimen (with or without background oral anticoagulation).
O
Outcome
All-cause strokehard clinical
Antiplatelet therapy in atrial fibrillation modestly reduces stroke only in the absence of oral anticoagulation, but universally increases major bleeding and intracranial hemorrhage.
Limitations
- Imprecision in evidence for stroke outcomes with background anticoagulation
- Asymmetry in funnel plots for stroke and ischaemic stroke suggesting potential publication bias or effect modification
Cite This Study
Benz et al. (2021) studied this question.
Topics
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