Key result
Triple therapy showed no significant difference in major adverse cardiovascular events compared to dual therapy (RR 0.82) in patients on oral anticoagulants undergoing coronary stenting.
Why the study?
Does triple therapy compared to dual therapy improve cardiovascular outcomes and safety in patients on oral anticoagulants undergoing PCI with stent implantation?
Meta-Analysis (n=30,823)
Yes
Does triple therapy compared to dual therapy improve cardiovascular outcomes and safety in patients on oral anticoagulants undergoing PCI with stent implantation?
Relative Risk: 0.82 (95% CI 0.58–1.17)
In patients on oral anticoagulants undergoing PCI, triple therapy showed similar rates of MACE compared to dual therapy but was associated with lower risks of MI and major bleeding, though outcomes were similar when compared specifically to OAC plus clopidogrel.
Supports dual therapy to limit bleeding without excess MACE; reinforces pooled RCT evidence for antithrombotic choice post-PCI.
BACKGROUND: A growing number of patients require oral anticoagulant (OAC) after undergoing percutaneous coronary intervention (PCI) with stent implantation due to the development of atrial fibrillation, but the optimal antithrombotic regimen remains controversial in these patients. METHODS: We systematically searched PUBMED, EMBASE, and CENTRAL from inception until September 2016 for randomized controlled trials or cohort studies that evaluated the comparative effects of TT versus DT. Relative risks (RRs) with 95% confidence intervals (95% CIs) were pooled by a random-effects model or a fixed-effects model. RESULTS: Twelve studies with a total of 30,823 patients were included in this analysis, including 6134 in the TT group and 24,689 in the DT group. No significant differences were found between the TT group and the DT group regarding major adverse cardiovascular events (MACE) (RR = 0.82, 95% CI: 0.58-1.17; I = 87.3%), stroke (RR = 1.08, 95% CI: 0.56-2.07; I = 65.5%), all-cause mortality (RR = 0.90, 95% CI: 0.54-1.51; I = 79.1%), or stent thrombosis (RR = 0.71, 95% CI: 0.41-1.24; I = 12.7%), and lower rates were observed for myocardial infarction (RR = 0.59, 95% CI: 0.50-0.70; I = 31.1%) and major bleeding with TT (RR = 0.86, 95% CI: 0.74-0.99; I = 24.3%). Meanwhile, we also found that compared with TT, OAC with clopidogrel treatment shows equal efficacy and safety outcomes. CONCLUSION: In patients on OAC undergoing PCI with stent implantation, compared with DT, TT shows equal effectiveness in terms of MACE, stroke, all-cause mortality, and stent thrombosis and lower risks of myocardial infarction and major bleeding. However, similar efficacy and safety outcomes were observed between the TT group and the OAC along with clopidogrel group.
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Chen et al. (2017) conducted a meta-analysis in Patients on oral anticoagulants requiring percutaneous coronary intervention (n=30,823). Triple therapy (oral anticoagulant, aspirin, and clopidogrel) vs. Dual therapy (oral anticoagulant and single antiplatelet) was evaluated on Major adverse cardiovascular events (MACE) (RR 0.82, 95% CI 0.58-1.17). Triple therapy showed no significant difference in major adverse cardiovascular events compared to dual therapy (RR 0.82) in patients on oral anticoagulants undergoing coronary stenting.
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