Dual-Antithrombotic Therapy With DOACs After Acute Coronary Syndrome or Percutaneous Coronary Intervention in Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials |
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| Affiliation: | 1. Cardiology Department, Health Sciences North, Sudbury, Ontario, Canada;2. Health Sciences North Research Institute, Sudbury, Ontario, Canada;3. Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada;4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;5. Electrophysiology Unit, Cardiology Department, Hillel Yaffe Medical Center, Hadera, Israel;6. Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;7. St Matthew’s University School of Medicine, Grand Cayman, Cayman Islands;8. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;1. Cardiovascular Research Institute, University Hospital Basel, Basel, Switzerland;2. Department of Internal Medicine, Rush University, Chicago, Illinois;3. Department of Electrophysiology, Charleston Hospital, Charleston, South Carolina;4. Division of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan;6. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany;5. Hospital Clínic de Barcelona, Servicio de Cardiología, Barcelona, Spain;7. Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium;11. St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom;12. Institute of Health Informatics Research, University College of London, London, United Kingdom;8. Department of Cardiology, Clinique St. Pierre, Perpignan, France;10. Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany;9. Department of Cardiology, Pasteur Hospital, University Hospital of Nice, Nice, France;71. National Medical Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Heart Rhythm and Conduction Disorder, Moscow, Russia;112. Isala Heart Centre, Zwolle, the Netherlands;123. Diagram, Zwolle, the Netherlands;84. Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBER de Enfermedades Cardiovasculares, Cardiovascular Institute, Madrid, Spain;106. Department of Cardiology, University Hospital Basel, Basel, Switzerland;95. National University Hospital, Singapore;77. Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan;1111. Cardiology Division – Electrophysiology, Sant''Andrea Hospital, Vercelli, Italy;1212. Center for Atrial Fibrillation, UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;88. Division of Cardiology “Città della Salute e della Scienza di Torino” Hospital, Department of Medical Sciences, University of Turin, Turin, Italy;1. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA;2. Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA;3. Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA;1. Cardiovascular Department, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy;2. Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Ferrara, Italy |
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| Abstract: | BackgroundThe choice of antithrombotic therapy for atrial fibrillation (AF) patients who have an acute coronary syndrome (ACS) or have undergone percutaneous coronary intervention (PCI) is challenging. We aimed to assess outcomes between dual-antithrombotic therapy with the use of direct-acting oral anticoagulants (DOACs) plus an antiplatelet agent (dual therapy) compared with warfarin plus 2 antiplatelet agents (triple therapy) for AF patients after PCI or with ACS.MethodsSystematic searches of multiple major databases were performed from their inception through September 2019. We included only randomized controlled trials. Odds ratios (ORs) were pooled with the use of a random-effects model.ResultsWe identified 4 randomized controlled trials, which included 7168 patients. Compared with triple-antithrombotic therapy with warfarin, dual-antithrombotic therapy with DOACs was associated with a significant reduction in major bleeding (OR 0.56, 95% confidence interval [CI] 0.38-0.82; P = 0.003) as well as major bleeding or clinically relevant nonmajor bleeding (OR 0.53, 95% CI 0.38-0.75; P < 0.001). The rate of composite of death and ischemic events (stroke and myocardial infarction) was not statistically different between groups (OR 1.21, 95% CI 0.99-1.49; P = 0.06). There was no significant difference between groups in the rate of death (OR 1.20, 95% CI 0.95-1.53; P = 0.13).ConclusionsIn patients with AF and recent ACS or PCI, the use of dual-antithrombotic therapy with DOACs was associated with less major bleeding and less major bleeding or clinically relevant nonmajor bleeding compared with triple therapy. The use of dual therapy also showed nonsignificantly higher composite of death and ischemic events but no difference in mortality. |
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