Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review andmeta-analysis of randomized clinical trials

Golwala, Harsh B.Harvard Med Sch, Brigham & Womens Hosp, Heart & Vasc Ctr, Boston, MA USA (author)

Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention : a systematic review andmeta-analysis of randomized clinical trials

Aims: Of patients with atrial fibrillation (AF), approximately 10% undergo percutaneous coronary intervention (PCI). We studied the safety and efficacy of dual vs. triple antithrombotic therapy (DAT vs. TAT) in this population.Methods and results: A systematic review and meta-analysis was conducted using PubMed, Embase, EBSCO, Cochrane database of systematic reviews, Web of Science, and relevant meeting abstracts for Phase 3, randomized trials that compared DAT vs. TAT in patients with AF following PCI. Four trials including 5317 patients were included, of whom 3039 (57%) received DAT. Compared with the TAT arm, Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding showed a reduction by 47% in the DAT arm [4.3% vs. 9.0%; hazard ratio (HR) 0.53, 95% credible interval (CrI) 0.36–0.85, I2 = 42.9%]. In addition, there was no difference in the trial-defined major adverse cardiac events (MACE) (10.4% vs. 10.0%, HR 0.85, 95% CrI 0.48–1.29, I2 = 58.4%), or in individual outcomes of all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, or stroke between the two arms.Conclusion: Compared with TAT, DAT shows a reduction in TIMI major or minor bleeding by 47% with comparable outcomes of MACE. Our findings support the concept that DAT may be a better option than TAT in many patients with AF following PCI.

Cannon, Christopher P.Harvard Med Sch, Brigham & Womens Hosp, Heart & Vasc Ctr, Boston, MA USA; Baim Inst Clin Res, Boston, MA USA (author)
Steg, Ph. GabrielFACT, Boston, MA USA; Univ Paris Diderot, Hop Bichat, AP HP, Paris, France; INSERM, Paris, France (author)
Doros, GheorgheBaim Inst Clin Res, Boston, MA USA; Boston Univ, Sch Publ Hlth, Dept Biostat, Crosstown Ctr, Boston, MA USA (author)
Qamar, ArmanHarvard Med Sch, Brigham & Womens Hosp, Heart & Vasc Ctr, Boston, MA USA (author)
Ellis, Stephen G.Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH USA (author)
Oldgren, Jonas,1964-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)jonaoldg (author)
ten Berg, Jurrien M.St Antonius Hosp Nieuwegein, Dept Cariol, CM Nieuwegein, Netherlands (author)
Kimura, TakeshiKyoto Univ Hosp, Dept Cardiovasc Med, Kyoto, Kyoto, Japan (author)
Hohnloser, Stefan H.Goethe Univ Frankfurt, Div Cardiac Electrophysiol, Dept Cardiol, Frankfurt, Germany (author)
Lip, Gregory Y. H.Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England (author)
Bhatt, Deepak L.Harvard Med Sch, Brigham & Womens Hosp, Heart & Vasc Ctr, Boston, MA USA (author)
Harvard Med Sch, Brigham & Womens Hosp, Heart & Vasc Ctr, Boston, MA USAHarvard Med Sch, Brigham & Womens Hosp, Heart & Vasc Ctr, Boston, MA USA; Baim Inst Clin Res, Boston, MA USA (creator_code:org_t)

In:European Heart Journal: Oxford University Press (OUP)39:19, s. 1726-+0195-668X1522-9645

By the author/editor: Golwala, Harsh B ...; Cannon, Christop ...; Steg, Ph. Gabrie ...; Doros, Gheorghe; Qamar, Arman; Ellis, Stephen G ...; show more...; Oldgren, Jonas, ...; ten Berg, Jurrie ...; Kimura, Takeshi; Hohnloser, Stefa ...; Lip, Gregory Y. ...; Bhatt, Deepak L.; show less...

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

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