Effects of Triple Therapy in Patients With Non-Valvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Regarding Thromboembolic Risk Stratification

Sambola, Antonia; Mutuberría, María; Blanco, Bruno García del; Alonso, Albert; Barrabés, José A.; Alfonso, Fernándo; Bueno, Héctor; Cequier, Ángel; Zueco, Javier; Rodríguez-Leor, Oriol; Bosch, Eduard; Tornos, Pilar; Garcı́a-Dorado, David

doi:10.1253/circj.cj-15-0923

Cited by 21 publications

(16 citation statements)

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“…However, the evidence related to these antithrombotic strategies has yielded conflicting results. Some of the studies have reported a decreased risk of thrombotic complications in patients on TT [ 4 , 5 ], whereas other studies have demonstrated that the high risk of bleeding associated with TT might outweigh its benefits [ 6 – 8 ]. Dual antithrombotic therapy was found to decrease the risk of major adverse cardiac events in a large study of patients with AF and IHD [ 9 ] but did not decrease the risk of coronary death or myocardial infarction (MI) in another study [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of triple versus dual antithrombotic therapy in atrial fibrillation and ischemic heart disease: a systematic review and meta-analysis

et al. 2017

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The optimal antithrombotic regimen for patients with atrial fibrillation and ischemic heart disease remains unclear. Therefore, we aimed to compare the efficacy and safety of triple therapy (TT [an anticoagulant and 2 antiplatelet drugs]) with dual therapy (DAPT [2 antiplatelet drugs] or DT [an anticoagulant and a single antiplatelet drug]) in patients with atrial fibrillation and ischemic heart disease. We systematically searched the Cochrane Library, PubMed and Embase databases for all relevant studies up to August 2017. The overall risk estimates were calculated using the random-effects model. A total of 17 observational studies were included. Regarding the efficacy outcomes, no differences were observed between the triple therapy and the dual therapy for all-cause death, cardiovascular death, or thrombotic complications (i.e., acute coronary syndrome, stent thrombosis, thromboembolism/stroke, and major adverse cardiac and cerebrovascular events). Regarding the safety outcomes, compared with DAPT, TT was associated with increased risks of major bleeding (a relative risk of 1.96 [1.40–2.74]), minor bleeding (1.69 [1.06–2.71]) and overall bleeding (1.80 [1.23–2.64]). Compared wtih DT, TT was associated with a greater risk of major bleeding (1.65 [1.23–2.21]), but rates of minor bleeding (0.99 [0.56–1.77]) and overall bleeding (1.14 [0.76–1.71]) were similar. Overall, TT confers an increased hazard of major bleeding with no thromboembolic protection compared with dual therapy in patients with atrial fibrillation and ischemic heart disease.

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of triple versus dual antithrombotic therapy in atrial fibrillation and ischemic heart disease: a systematic review and meta-analysis

et al. 2017

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“…Where author groups published more than one study from largely the same patient population (Sambola et al . [ 9 , 10 ], Lamberts et al . [ 11 , 12 ] & Fosbol et al .…”

Section: Resultsmentioning

confidence: 99%

“…Of the 10 studies, only Sambola et al . (2016) [ 9 ] and Rubboli et al . (2014) [ 15 ] were prospective in nature.…”

Section: Resultsmentioning

confidence: 99%

Triple Therapy Versus Dual Antiplatelet Therapy for Patients with Atrial Fibrillation and Acute Coronary Syndromes: A Systematic Literature Review

Fake

Ranchord²,

Harding³

et al. 2017

CCR

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Background: Patients with acute coronary syndromes (ACS) and a history of atrial fibril-lation (AF) have indications for both dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC). Triple therapy (TT), the combination of DAPT and OAC, is recommended in guidelines. We examined studies comparing clinical outcomes on DAPT versus TT for patients with AF and ACS.Methods: We searched Medline, Medline pending, EMBASE and Evidence-Based Medicine Re-views databases for studies published between January 2000 to December 2016 in AF patients with ACS that compared DAPT and TT that reported ischaemic and/or bleeding outcomes. Studies that were not purely an AF population were excluded.Results: Ten studies were included in the review, all of which were observational, 8 of which were retrospective. None of the studies detailed the specifics of treatment allocation. All but one were of AF patients with a mix of stable coronary disease and ACS patients. TT was associated with in-creased bleeding when compared to DAPT, with adjusted odds ratios ranging from 1.25 to 6.84. While the largest study reported a reduction in stroke associated with TT (odds ratio 0.67), two other studies reported non-significant increases in stroke with TT. Variable composite ischaemic endpoints were reported, none showing a statistical significant difference between DAPT and TT.Conclusion: In patients with ACS and AF, TT is likely to be associated with increased risk of bleed-ing, without a clear reduction in ischaemic endpoints. The quality of the evidence to support current guidelines for this patient group was generally poor.

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“…34 However, there is no evidence regarding a reduced dose of DOACs in patients with AF requiring PCI. Because AF patients requiring OAC have a much higher risk of stroke than ACS patients, 35 further dedicated research comparing reduced and standard doses of DOACs in patients undergoing PCI with AF is necessary.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Long-Term Clinical Outcomes of Vitamin K Antagonist and Direct Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Yoshida

Morishima

Takagi

et al. 2018

Circ J

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Effects of Triple Therapy in Patients With Non-Valvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Regarding Thromboembolic Risk Stratification

Cited by 21 publications

References 50 publications

Efficacy and safety of triple versus dual antithrombotic therapy in atrial fibrillation and ischemic heart disease: a systematic review and meta-analysis

Efficacy and safety of triple versus dual antithrombotic therapy in atrial fibrillation and ischemic heart disease: a systematic review and meta-analysis

Triple Therapy Versus Dual Antiplatelet Therapy for Patients with Atrial Fibrillation and Acute Coronary Syndromes: A Systematic Literature Review

Comparison Between Long-Term Clinical Outcomes of Vitamin K Antagonist and Direct Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

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