Anti-thromboembolic strategies in atrial fibrillation

Cocco, Giuseppe; Amiet, Philpp; Jerie, P

doi:10.5603/cj.a2016.0004

Cited by 6 publications

(8 citation statements)

References 45 publications

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“…From our results, TT was associated with 1.55-fold increased risk of major bleeding, which was lower than 2-5-fold risk reported in several studies [ 25 , 26 ]. Especially, TT did not increase the risk of MACE and all-cause mortality irrespective of the increased major bleeding risk.…”

Section: Discussioncontrasting

confidence: 68%

“…In terms of the incidence of major bleeding in our analysis, it was difficult to compare the absolute rate among studies owing to the different bleeding definitions, follow-up duration and comorbidities in each studies. Besides, a target international normalized ratio (INR) between 2.0–2.5 in this setting of patients on TT, which could significantly reduce the major bleeding, was recommended by several studies [ 11 , 15 , 17 , 25 , 28 ]. Moreover, a prospective multicenter registry [ 10 ] demonstrated that in non-valvular AF patient undergoing PCI with CHA2DS2-VASc scores = 1, TT was associated with a high risk of bleeding without a significant benefit in thromboembolism prevention.…”

Section: Discussionmentioning

confidence: 99%

“…Another included study [ 17 ] also suggested benefits of TT with CHADS 2 >2. On the other hand, TT had a lower mortality risk in AF patient post coronary stenting even with a HAS-BLED score of 3 or higher [ 12 , 25 ], and the choice of OAC may accord to the risk of thromboembolism [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of triple therapy versus dual antiplatelet therapy in patients with atrial fibrillation undergoing coronary stenting: A meta-analysis

et al. 2018

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BackgroundThe optimal antithrombotic therapy for atrial fibrillation (AF) patients undergoing coronary stenting is unknown. The present meta-analysis sought to investigate the efficacy and safety of triple therapy (TT; warfarin, clopidogrel and aspirin) vs dual antiplatelet therapy (DAPT; clopidogrel plus aspirin) in those patients.MethodsPubMed and Cochrane Library were searched for studies enrolling AF patients undergoing coronary stenting on TT and DAPT up to September 2016, and fourteen studies were included. Efficacy outcomes included ischemic stroke, stent thrombosis, major adverse cardiovascular event (MACE), all-cause mortality and myocardial infarction (MI); safety outcome was major bleeding. We conducted meta-analysis and used odds ratio (OR) with 95% confidence intervals (CI) to compare TT and DAPT. Meta-regression, sensitivity and subgroup analysis were taken to investigate the source of heterogeneity in the outcome of major bleeding.Results14 eligible observational studies with 11,697 subjects were identified. Compared with DAPT, TT had decreased the risk of ischemic stroke [OR = 0.74, 95% CI (0.59, 0.93), P = 0.009] and stent thrombosis [OR = 0.40, 95% CI (0.18, 0.93), P = 0.033]. While, there was an increased risk of major bleeding [OR = 1.55, 95% CI (1.16, 2.09), P = 0.004] associated with TT. The risk of MACE, all-cause mortality and MI had no significant statistical difference between TT and DAPT. Furthermore, the results of univariate and multivariate meta-regression analysis implicated that there were no obvious correlations between certain baseline characteristics (age, gender, race, hypertension, study design) and risk of major bleeding. Also of major bleeding, the findings of sensitivity analysis were generally robust, and a prespecified subgroup analysis of race demonstrated that the source of heterogeneity might attribute to Asian studies mostly.ConclusionsTT reduced the risk of ischemic stroke and stent thrombosis with an acceptable major bleeding risk compared with DAPT, and TT was considered as a valid alternative in AF patients undergoing coronary stenting. Further prospective randomized trials are needed to ensure the reliability of these data and find the optimal therapeutic strategy in this setting of patients.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of triple therapy versus dual antiplatelet therapy in patients with atrial fibrillation undergoing coronary stenting: A meta-analysis

et al. 2018

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“…Vitamin K antagonists (e.g., warfarin) are commonly used in patients with artificial heart valves, deep vein thrombosis, etc. ( Key and Kasthuri, 2010 ; Andras et al, 2012 ; Cocco et al, 2016 ). According to the guidelines developed at the Academic Centre for Dentistry Amsterdam (ACTA), the INR of the patients taking vitamin K antagonists (which is measured within 24–72 h preoperatively) must be ≤3.5 ( Broekema et al, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

Post-operative Bleeding Risk in Dental Surgery for Patients on Oral Anticoagulant Therapy: A Meta-analysis of Observational Studies

Shi

Zhang

et al. 2017

Front. Pharmacol.

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Background and Objective: Minor dental surgery is invasive and hemorrhagic. Thus, in patients treated with anticoagulants, the bleeding risk related to these invasive procedures is concerning. The aim of this meta-analysis is to evaluate this risk by comparing the post-operative bleeding rates of oral anticoagulation treatment (OAT) patients (without interrupted or altered anticoagulant intake) with non-OAT patients.Methods: PubMed, Embase and the Cochrane Library were searched for eligible studies that compared the post-operative (following minor dental surgery) bleeding rates of OAT patients without interrupted or altered therapy with those of non-OAT patients. Relative risk (RR) and 95% confidence interval (CI) were calculated. Subgroup analyses were used to identify the association between the bleeding rate and different dental surgeries or anticoagulants.Results: Thirty two full text articles were assessed for eligibility and 20 studies were excluded according to the selection criteria. Finally, 12 studies and a total of 2102 OAT patients and 2271 non-OAT patients were included. A pooled analysis indicated that the post-operative bleeding risk in OAT patients is higher than that of non-OAT patients (RR: 2.794, 95% CI: 1.722–4.532, P = 0.000). The pooled RRs in the dental implant surgery and dental extraction subgroups were 2.136 (95% CI: 0.825–5.531, P = 0.118) and 2.003 (95% CI: 0.987–4.063, P = 0.054), respectively. As for the different oral anticoagulants, the pooled RR in the subgroup of new oral anticoagulants (NOACs) was 1.603 (95% CI: 0.430–5.980, P = 0.482), while the pooled RR in the vitamin K antagonists subgroup was 3.067 (95% CI: 1.838–5.118, P = 0.000).Conclusion: Under current evidence, OAT patients were under a higher post-operative bleeding risk than the non-OAT patients following minor dental surgery. For the dental implant surgeries and dental extractions, our study failed to demonstrate a higher risk of bleeding in the OAT patients compared with the non-OAT patients. Besides, The NOACs might be safer than the vitamin K antagonists in dental implant surgery. However, more well-designed studies are required for future research.

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“…So far there was lack of large outcome trials comparing VKAs and NOACs in patients with AF undergoing PCI for acute coronary syndromes or for stable coronary artery disease, in particular subset treated with single-or dual-antiplatelet therapy [124]. New data coming from randomized clinical trials on NOACs post-PCI have emerged.…”

Section: Use Of Noacs In Combination With Antiplatelet Therapy As a Pmentioning

confidence: 99%

Use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation — Messages from the 2018 EHRA

et al. 2018

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Anti-thromboembolic strategies in atrial fibrillation

Abstract: Oral anticoagulation (OAC) is highly effective for stroke prevention in high-risk-patients with atrial fibrillation (AF). (Cardiol J 2016; 23, 2: 211-223)

Cited by 6 publications

References 45 publications

Efficacy and safety of triple therapy versus dual antiplatelet therapy in patients with atrial fibrillation undergoing coronary stenting: A meta-analysis

Efficacy and safety of triple therapy versus dual antiplatelet therapy in patients with atrial fibrillation undergoing coronary stenting: A meta-analysis

Post-operative Bleeding Risk in Dental Surgery for Patients on Oral Anticoagulant Therapy: A Meta-analysis of Observational Studies

Use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation — Messages from the 2018 EHRA

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