The safety and efficacy of oral anticoagulants with dual versus single antiplatelet therapy in patients after percutaneous coronary intervention

Chen, Jie; Wang, Li-Yu; Deng, Chao; Jiang, Xinghua; Chen, Tu-Gang

doi:10.1097/md.0000000000008015

Cited by 6 publications

(4 citation statements)

References 37 publications

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“…Current guidelines recommend a short course of triple antithrombotic therapy, including OAC and DAPT, in patients with OAC indication who are undergoing PCI [18]. Several meta-analyses comparing the safety and efficacy of dual and triple antithrombotic therapies in these high risk patients are summarized in Table 1 [13][14][15][19][20][21][22][23][24][25][26]. The network meta-analysis performed by Gong et al showed that the combination of VKA with single antiplatelet therapy (SAPT) yielded the best safety and efficacy, with a very low dose of rivaroxaban and DAPT deemed to be an acceptable alternative to standard triple therapy with VKA and DAPT [21].…”

Section: Dual Versus Triple Antithrombotic Therapymentioning

confidence: 99%

Antithrombotic Strategies in Patients with Atrial Fibrillation Following Percutaneous Coronary Intervention: A Systemic Review and Network Meta-Analysis of Randomized Controlled Trials

Chua

Chen²,

Shyu³

et al. 2020

JCM

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Up to 10% of patients with atrial fibrillation (AF) undergo percutaneous coronary intervention (PCI). A systematic review and network meta-analysis were conducted by searching PubMed, Embase, and the Cochrane database of systematic reviews for randomized control trials that studied the safety and efficacy of different antithrombotic strategies in these patients. Six studies, including 12,158 patients were included. Compared to that in the triple antithrombotic therapy group (vitamin K antagonist (VKA) plus P2Y12 inhibitor and aspirin), thrombolysis in myocardial infarction (TIMI) major bleeding was significantly reduced in the dual antithrombotic therapy (non-vitamin K oral anticoagulants (NOACs) plus P2Y12 inhibitor) group by 47% (Odds ratio (OR), 0.53; 95% credible interval [CrI], 0.35–0.78; I2 = 0%). Besides, NOAC plus a P2Y12 inhibitor was associated with less intracranial hemorrhage compared to VKA plus single antiplatelet therapy (OR: 0.20, 95% CrI: 0.05–0.77). There was no significant difference in the trial-defined major adverse cardiac events or the individual outcomes of all-cause mortality, cardiovascular death, myocardial infarction, stroke or stent thrombosis among all antithrombotic strategies. In conclusion, antithrombotic strategy of NOACs plus P2Y12 inhibitor is safer than, and as effective as, the strategies including aspirin when used in AF patients undergoing PCI.

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Section: Dual Versus Triple Antithrombotic Therapymentioning

confidence: 99%

Antithrombotic Strategies in Patients with Atrial Fibrillation Following Percutaneous Coronary Intervention: A Systemic Review and Network Meta-Analysis of Randomized Controlled Trials

Chua

Chen²,

Shyu³

et al. 2020

JCM

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“…As ischemic events are less frequent than bleeding outcomes in this population, these studies have not been adequately powered to detect a difference in ischemic endpoints. Prior meta‐analyses have achieved adequate power but have considered OAC with aspirin and OAC with P2Y12 inhibitor as equivalent double therapy regimens . They have also included patients with other indications for oral anticoagulation (OAC; such as pulmonary embolism or mechanical valve), which limits clinical utility in patient with AF .…”

Section: Introductionmentioning

confidence: 99%

“…Prior meta-analyses have achieved adequate power but have considered OAC with aspirin and OAC with P2Y12 inhibitor as equivalent double therapy regimens. [7][8][9][10] They have also included patients with other indications for oral anticoagulation (OAC; such as pulmonary embolism or mechanical valve), which limits clinical utility in patient with AF. [7][8][9][10] We set out to perform a systematic review and metaanalysis to evaluate the safety and efficacy of double therapy, specifically with an OAC and P2Y12 inhibitor compared to traditional triple therapy with OAC, P2Y12 inhibitor, and aspirin, in preventing ischemic events.…”

mentioning

confidence: 99%

A systematic review of randomized trials comparing double versus triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention

Sullivan

Nanna

Rao

et al. 2019

Cathet Cardio Intervent

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Background: Prior randomized controlled trials (RCT) evaluating the optimal antithrombotic therapies for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have not been powered to evaluate ischemic outcomes. We compared double therapy with oral anticoagulation (OAC) and a P2Y12 inhibitor to triple therapy with an OAC + dual antiplatelet therapy in patients with AF requiring PCI. Methods: Using PRISMA guidelines, we searched for RCTs including patients with AF as an indication for OAC and undergoing PCI or medical management of acute coronary syndrome. The results were pooled using fixed-effects and random-effects models to estimate the overall effect of double therapy versus triple therapy on ischemic and bleeding outcomes. Results: We identified four RCTs, comprising 10,238 patients (5,498 double therapy, 4,740 triple therapy). Trial-reported major adverse cardiovascular events were similar between double therapy and triple therapy (fixed effect model OR 1.09, 95% CI 0.94-1.26). However, stent thrombosis (61/5,496 double therapy vs. 33/4738 triple therapy; fixed effect model OR 1.57, 95% CI 1.02-2.40; number needed to treat with triple therapy = 242) favored triple therapy. Bleeding outcomes were less frequent with double therapy (746/5470 vs. 950/4710; fixed effect model OR 0.59, 95% CI 0.53-0.65; number needed to harm with triple therapy = 16), but with significant heterogeneity (Q = 8.33, p = .04; I 2 = 64%), as were intracranial hemorrhages (19/5470 vs. 30/4710; fixed effect model OR 0.54, 95% CI 0.31-0.96).

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“…When patients are complicated with acute myocardial infarction (AMI), the risk of atrial fibrillation is even higher than 15% ( 1 ). Atrial fibrillation complications may lead to an increase in ventricular rate, further increasing the myocardial oxygen consumption, and aggravating myocardial ischemia and hypoxia ( 2 ). A large number of studies have confirmed ( 3 – 5 ) that atrial fibrillation is an independent risk factor for MI in patients with coronary heart disease.…”

Section: Introductionmentioning

confidence: 99%

Effects of atrial fibrillation on complications and prognosis of patients receiving emergency PCI after acute myocardial infarction

Zhang

Zheng

et al. 2018

Exp Ther Med

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The effects of atrial fibrillation on complications and prognosis of patients receiving emergency percutaneous coronary intervention after acute myocardial infarction (AMI) were investigated. Eighty AMI patients treated with interventional vascular recanalization in the Affiliated Hospital of Weifang Medical University (Weifang, China) from July 2015 to October 2016 were selected, including 40 patients complicated with atrial fibrillation before operation (control group) and 40 patients without atrial fibrillation before operation (observation group). The systolic blood pressure, diastolic blood pressure, heart rate, arrhythmia and common complications after MI were compared. Changes in the coronary artery thrombolysis in myocardial infarction (TIMI) flow grade and left ventricular ejection fraction (LVEF) of patients were also recorded. Moreover, changes in brain natriuretic peptide (BNP) levels were compared. The recovery time of myocardial enzyme and total troponin in both groups was recorded. The systolic and diastolic blood pressure in the observation group were significantly higher than those in the control group (p<0.05). During the intervention, the total proportion of patients with ventricular arrhythmia, atrial arrhythmia, atrioventricular block and sinus tachycardia in the observation group was significantly lower than that in the control group (p<0.05). The total proportion of common complications after MI in the observation group was obviously lower than that in the control group (p<0.05). Coronary artery TIMI flow grades and LVEFs in the observation group were obviously higher than those in the control group. BNP levels in the observation group were significantly lower than those in the control group. The recovery time of myocardial enzyme and total troponin in the observation group was significantly earlier than that in the control group. Atrial fibrillation has a certain negative effect on the circulatory function in patients with AMI after the interventional therapy, and the proportions of arrhythmia and complications in patients after MI are increased at the same time, so the postoperative recovery of patients is slow with many complications.

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The safety and efficacy of oral anticoagulants with dual versus single antiplatelet therapy in patients after percutaneous coronary intervention

Abstract: Supplemental Digital Content is available in the text

Cited by 6 publications

References 37 publications

Antithrombotic Strategies in Patients with Atrial Fibrillation Following Percutaneous Coronary Intervention: A Systemic Review and Network Meta-Analysis of Randomized Controlled Trials

Antithrombotic Strategies in Patients with Atrial Fibrillation Following Percutaneous Coronary Intervention: A Systemic Review and Network Meta-Analysis of Randomized Controlled Trials

A systematic review of randomized trials comparing double versus triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention

Effects of atrial fibrillation on complications and prognosis of patients receiving emergency PCI after acute myocardial infarction

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