Evaluation of the efficacy and safety of dual antiplatelet therapy with or without warfarin in patients with a clinical indication for DAPT and chronic anticoagulation: A meta‐analysis of observational studies

Bavishi, Chirag; Koulova, Anna; Bangalore, Sripal; Sawant, Ashwin; Chatterjee, Saurav; Ather, Sameer; Valencia, José; Sarafoff, Nikolaus; Rubboli, Andrea; Airaksinen, Juhani; Lip, Gregory Y.H.; Tamis‐Holland, Jacqueline E.

doi:10.1002/ccd.26234

Cited by 20 publications

(14 citation statements)

References 42 publications

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“…In triple therapy patients older than 70 years, the bleeding rate in this study was in the 15‐28% range versus 0.0% in the sub‐septuagenarian age group. This, however, is also in agreement with recent findings by Bavishi et al who conducted a meta‐analysis of observational studies.…”

Section: Discussionsupporting

confidence: 93%

9‐month results of polymer‐free sirolimus eluting stents in young patients compared to a septuagenarian and octogenarian all‐comer population

Kherad¹,

Waliszewski

Leschke

et al. 2017

J Interven Cardiology

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Section: Discussionsupporting

confidence: 93%

9‐month results of polymer‐free sirolimus eluting stents in young patients compared to a septuagenarian and octogenarian all‐comer population

Kherad¹,

Waliszewski

Leschke

et al. 2017

J Interven Cardiology

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“…1,7 Moreover, trials have shown that triple therapy after PCI is associated with a twofold increase in bleeding in the patients relative to double therapy, and post-PCI bleeding events are linked to worse MACE outcomes, possibly from the interruption in antithrombotic therapy during bleeding events. [28][29][30][31][32] It has been shown that double therapy is enough for most patients with AF, and ACS/ PCI and triple therapy may increase the risk of bleeding. 27,33,34 We have shown that double therapy with DOACs is safe and as effective as triple therapy with VKA.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of direct oral anticoagulants compared to Vitamin K antagonists postpercutaneous coronary interventions in patients with atrial fibrillation: A systematic review and meta‐analysis

Agasthi

Lee

Pujari

et al. 2020

Journal of Arrhythmia

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Background Atrial fibrillation (AF) and coronary artery disease (CAD) are commonly associated. Cotreatment with multiple antithrombotic agents can increase the risk of bleeding. We sought to evaluate patient‐centered outcomes in patients with AF on double therapy with direct oral anticoagulants (DOACs) compared to patients with standard triple therapy, [a vitamin K antagonist (VKA) plus dual antiplatelet therapy]. Methods We performed a literature search of randomized controlled trials (RCTs) reporting outcomes of patients receiving double therapy with DOACs compared to triple therapy with VKAs in patients with AF undergoing percutaneous coronary intervention (PCI). Patient‐centered outcomes were the International Society of Thrombosis and Hemostasis (ISTH) major or clinically relevant nonmajor bleeding (CRNB), all‐cause mortality, major adverse cardiovascular events (MACE), stent thrombosis, myocardial infarction, and stroke. Results Four RCTs (9602 patients) met our inclusion criteria. Compared to VKAs, DOACs were associated with significantly lower ISTH major bleeding/ CRNB (RR: 0.75, 95% CI: 0.67‐0.82, P < .00001, I2 = 11%). There were no statistically significant differences in the efficacy outcomes, including myocardial infarction (RR: 0.99, 95% CI :0.79‐1.25, P = .96), stent thrombosis (RR: 0.97, 95% CI: 0.6‐1.55, P = .89), ischemic stroke (RR: 0.76, 95% CI: 0.5‐1.15, P = .19), all‐cause mortality (RR: 1.06, 95% CI: 0.85‐1.31, P = .61), and MACE (RR: 1.06, 95% CI: 0.91‐1.22, P = .97). Conclusion Compared with triple therapy with VKAS, double therapy with DOACs is associated with a reduced risk of bleeding and is as effective in patients with AF undergoing PCI.

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“…22 Randomized clinical trials showed that TAT after PCI in AF patients is associated with twofold increased in the incidence of bleeding events compared with DAT. 3,23,24 In patients who experience significant bleeding events after PCI, antiplatelet and antithrombotic agents are sometimes partially or completely discontinued, that in turn, will increase the ischemic events. 25 Therefore, it is essential to identify patients with AF and ACS undergoing PCI who are at high risk for bleeding events, before starting the therapy with DAT or TAT.…”

Section: Guidance For Choosing Dat or Tat In Daily Clinical Practicementioning

confidence: 99%

Double Antithrombotic versus Triple Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome

Dharma

2020

Int J Angiol

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In atrial fibrillation (AF), oral anticoagulant (OAC) therapy with either vitamin K antagonist or non–vitamin K antagonist is used to prevent thromboembolic complications. In patients who presented with acute coronary syndrome (ACS) and were treated by percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor reduces major adverse cardiac events (MACEs) and stent thrombosis. Consequently, in patients with AF who presented with ACS and were treated by PCI, the combination of OAC and DAPT, the so-called triple antithrombotic therapy (TAT) is needed to improve the outcome of the patients. However, the use of TAT increases the risk of bleeding. Several randomized clinical trials and a meta-analysis evaluated the use of TAT and double antithrombotic therapy (DAT) in this population, and DAT is defined as patients who receive combination of one antiplatelet and OAC. In general, the studies demonstrated a reduction in bleeding event in patients who received DAT as compared with TAT, with similar incidence of thromboembolic complications and MACE. To date, there is no established consensus or guideline for the most appropriate combination of antithrombotic agents in patients with AF and ACS who undergo PCI. Tailoring the treatment for each individual is likely the best approach to determine the balance of bleeding risk and ischemic events before starting antithrombotic therapy. Future trials with adequate sample size are needed to find the most appropriate combination of antiplatelet and OAC in patients with AF who presented with ACS and treated by PCI.

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Evaluation of the efficacy and safety of dual antiplatelet therapy with or without warfarin in patients with a clinical indication for DAPT and chronic anticoagulation: A meta‐analysis of observational studies

Abstract: All-cause mortality appears similar in patients treated with TT or DAPT although TT was associated with higher rates of major bleeding and a lower risk for ischemic stroke. © 2015 Wiley Periodicals, Inc.

Cited by 20 publications

References 42 publications

9‐month results of polymer‐free sirolimus eluting stents in young patients compared to a septuagenarian and octogenarian all‐comer population

9‐month results of polymer‐free sirolimus eluting stents in young patients compared to a septuagenarian and octogenarian all‐comer population

Safety and efficacy of direct oral anticoagulants compared to Vitamin K antagonists postpercutaneous coronary interventions in patients with atrial fibrillation: A systematic review and meta‐analysis

Double Antithrombotic versus Triple Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome

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