Key result
Triple antithrombotic therapy showed no significant differences compared to dual therapy in all-cause mortality (P=0.70), stent thrombosis, myocardial infarction, stroke, or major bleeding.
Why the study?
Does triple antithrombotic therapy compared to dual therapy with OAC and clopidogrel improve ischemic outcomes or increase bleeding in patients on oral anticoagulation after PCI?
Meta-Analysis (n=7,259)
Does triple antithrombotic therapy compared to dual therapy with OAC and clopidogrel improve ischemic outcomes or increase bleeding in patients on oral anticoagulation after PCI?
p-value: p=0.70
In patients on oral anticoagulation undergoing PCI, triple antithrombotic therapy showed no significant difference in mortality, ischemic, or hemorrhagic complications compared to dual therapy with OAC and clopidogrel.
Challenges routine triple antithrombotic therapy post-PCI in OAC patients; confirms equivalent ischemic and bleeding outcomes versus dual therapy.
BACKGROUND: In patients on oral anticoagulation (OAC), dual antiplatelet therapy (DAPT) is often indicated after percutaneous coronary intervention (PCI). AREAS OF UNCERTAINTY: We sought to investigate the effects of triple antithrombotic therapy (TT) versus dual therapy (DT) with OAC and clopidogrel on all-cause mortality, cardiovascular death, major bleeding, myocardial infarction (MI), stroke, and stent thrombosis. DATA SOURCES: We systematically searched on MEDLINE, EMBASE, and CENTRAL for randomized controlled or cohort studies, which investigated the comparative effects of TT versus DT. We performed a meta-analysis of 6 studies (1 randomized control study and 5 cohort studies). RESULTS: The included studies enrolled 7259 patients; 4630 (63.8%) were on TT and 2629 (36.2%) were on DT. The average follow-up time was 1.4 years. No significant differences were found between TT and DT in all-cause mortality (P = 0.70; I = 64%), stent thrombosis (P = 0.41), myocardial infarction (P = 0.43; I = 0%), stroke (P = 0.36; I = 0%), and major bleeding (P = 0.43; I = 0%). CONCLUSIONS: In patients who are on OAC with vitamin K antagonist and underwent percutaneous coronary intervention, no significant differences were found in mortality, ischemic, and hemorrhagic complications between the patients treated with TT and DT. Thus, tailored treatment based on individual thromboembolic and bleeding risk might be the most reasonable approach in these patients.
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Palla et al. (2016) conducted a meta-analysis in Patients on oral anticoagulation after percutaneous coronary intervention (n=7,259). Triple antithrombotic therapy (OAC and dual antiplatelet therapy) vs. Dual therapy with OAC and clopidogrel was evaluated on All-cause mortality (p=0.70). Triple antithrombotic therapy showed no significant differences compared to dual therapy in all-cause mortality (P=0.70), stent thrombosis, myocardial infarction, stroke, or major bleeding.
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