Key result
Triple therapy linked to ~2.4-fold higher major bleeding vs dual therapy in AF with CAD.
Why the study?
Patients with AF and CAD often require combined antithrombotic therapy, but the optimal balance between preventing thromboembolic and ischemic events and reducing bleeding risk remains uncertain.
Does dual antithrombotic therapy reduce major bleeding while maintaining comparable efficacy against thromboembolic and ischemic events compared to triple antithrombotic therapy in patients with atrial fibrillation and coronary artery disease?
Cohort (n=238)
No
Does dual antithrombotic therapy reduce major bleeding while maintaining comparable efficacy against thromboembolic and ischemic events compared to triple antithrombotic therapy in patients with atrial fibrillation and coronary artery disease?
In patients with atrial fibrillation and coronary artery disease, dual antithrombotic therapy provides comparable protection against thromboembolic and ischemic events compared to triple therapy while significantly reducing major and clinically relevant bleeding.
Background: Patients with atrial fibrillation (AF) and coronary artery disease (CAD) often require combined antithrombotic therapy, but the optimal balance between prevention of thromboembolic and ischemic events and reduction of bleeding risk remains uncertain. Objective: This study compared clinical outcomes associated with dual versus triple antithrombotic therapy in this high-risk population. Methods: This retrospective comparative cohort study was conducted at Army Cardiac Hospital Lahore from January 06, 2026 to August 05, 2026, included 238 patients with AF and CAD, of whom 118 received dual antithrombotic therapy and 120 received triple antithrombotic therapy. Clinical outcomes including thromboembolic events, myocardial infarction, stent thrombosis, major bleeding, clinically relevant non-major bleeding, and mortality were evaluated and compared between groups. Results: Thromboembolic events were observed in 10.2% of patients receiving dual therapy and 8.3% receiving triple therapy (p=0.62), while rates of myocardial infarction, stent thrombosis, and major adverse cardiovascular events were also comparable between groups. Major bleeding occurred significantly less frequently in the dual therapy group compared with the triple therapy group (7.6% vs 17.5%, p=0.03). Clinically relevant non-major bleeding was also lower with dual therapy (14.4% vs 25.0%, p=0.04). Multivariable analysis identified triple therapy and elevated HAS-BLED score as independent predictors of major bleeding. Conclusion: Dual antithrombotic therapy demonstrated comparable efficacy to triple therapy for prevention of thromboembolic and ischemic events while significantly reducing bleeding complications.
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Zia et al. (2026) conducted a cohort in Atrial fibrillation with concomitant coronary artery disease (n=238). Dual antithrombotic therapy (oral anticoagulant plus single antiplatelet agent) vs. Triple antithrombotic therapy (oral anticoagulant plus dual antiplatelet therapy) was evaluated on Major bleeding (Adjusted OR 2.41 (for triple vs dual therapy), 95% CI 1.18-4.92, p=0.03). Dual antithrombotic therapy significantly reduced major bleeding (7.6% vs 17.5%, p=0.03) with comparable thromboembolic rates (10.2% vs 8.3%, p=0.62) compared to triple therapy in AF with CAD.
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