Direct oral anticoagulants versus standard triple therapy in atrial fibrillation and PCI: meta-analysis

Open Heart
Natale Daniele BrunettiMatteo Di Biase

Abstract

The coexistence of coronary artery disease and atrial fibrillation (AF) in the same individuals raises great concern about the co-treatment with different antithrombotic agents in the case of percutaneous coronary interventions (PCI). The advent of direct oral anticoagulants (DOACs) revolutionised the therapy of AF; less is known, however, about the safety and efficacy of therapy with DOACs in combination with antiplatelet agents after PCI. We performed a meta-analysis of randomized controlled studies enrolling patients with nonvalvular AF undergoing PCI. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for any bleeding (AB), cardiovascular events (CVE), major bleeding (MB), myocardial infarction (MI), and stent thrombosis (ST) at follow-up: 4849 patients have been included in the analysis. When compared with patients receiving standard triple therapy (vitamin-K antagonists plus double antiplatelet therapy [VKAs plus DAPT]), patients receiving DOACs (rivaroxaban/dabigatran plus either one or two antiplatelet agents) had a statistically significant lower risk of AB (RR, 0.66; 95% CI, 0.59-0.75, p<0.00001), as well as of MB (RR, 0.59; 95% CI, 0.47-0.73, p<0.00001). Equivalent efficacy was found about ...Continue Reading

References

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Citations

Aug 7, 2019·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Fabrizio D'AscenzoGaetano M De Ferrari
Aug 14, 2020·Journal of Cardiovascular Pharmacology and Therapeutics·Robert N KerleyRonan Curtin
Dec 21, 2019·The Cochrane Database of Systematic Reviews·Samer Al SaidDaniel Duerschmied
Jan 10, 2021·Journal of Thrombosis and Thrombolysis·Megan E BassCourtney Shakowski

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NCT02635230
NCT02866175

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