Nayan Agarwal1, Ankur Jain1, Ahmed N Mahmoud1, Rohit Bishnoi1, Harsh Golwala2, Ashkan Karimi1, Mohammad Khalid Mojadidi1, Jalaj Garg3, Tanush Gupta4, Nimesh Kirit Patel5, Siddharth Wayangankar1, R David Anderson6. 1. Department of Medicine, University of Florida, Gainesville. 2. Department of Medicine, Brigham and Women's Hospital, Boston, Mass. 3. Department of Medicine, Lehigh Valley Hospital, Allentown, Pa. 4. Department of Medicine, Montefiore Medical Centre, Albert Einstein College of Medicine, Bronx, NY. 5. Department of Medicine, Virginia Commonwealth University Health System, Richmond. 6. Department of Medicine, University of Florida, Gainesville. Electronic address: david.anderson@medicine.ufl.edu.
Abstract
BACKGROUND: Choosing an antithrombotic regimen after coronary intervention in patients with concomitant indication for anticoagulation is a challenge commonly encountered by clinicians. METHODS: We performed a meta-analysis of observational studies and randomized, controlled trials comparing outcomes of triple therapy (dual antiplatelet therapy and anticoagulant) with dual therapy (single antiplatelet therapy and anticoagulant) in patients taking long-term anticoagulants after percutaneous coronary intervention. Major bleeding was the primary outcome. Random effects overall risk ratios (RRs) were calculated using the DerSimonian and Laird model. RESULTS: Nine observational studies and 2 randomized controlled trials with a total of 7276 patients met our selection criteria. At a mean follow-up of 10.8 months major bleeding was higher in the triple therapy cohort compared with dual therapy (6.6% vs 3.8%; RR 1.54; 95% confidence interval [CI], 1.2-1.98; P <.01). No difference was observed between the 2 groups for all-cause mortality (RR 0.98; 95% CI, 0.68-1.43; P = .93), major adverse cardiac events (RR 1.03; 95% CI, 0.8-1.32; P = .83), thromboembolic events (RR 1.02; 95% CI, 0.49-2.10; P = .96), myocardial infarction (RR 0.85; 95% CI, 0.67-1.09; P = .21), stent thrombosis (RR 0.77; 95% CI, 0.46-1.3; P = .33), and target vessel revascularization (RR 0.87; 95% CI, 0.66-1.15; P = .33). CONCLUSION: In patients receiving anticoagulant therapy, a strategy of single antiplatelet therapy confers a benefit of less major bleeding with no difference in all-cause mortality, cardiovascular mortality, major adverse cardiac events, myocardial infarction, stent thrombosis, or thromboembolic event rate compared with dual antiplatelet therapy.
BACKGROUND: Choosing an antithrombotic regimen after coronary intervention in patients with concomitant indication for anticoagulation is a challenge commonly encountered by clinicians. METHODS: We performed a meta-analysis of observational studies and randomized, controlled trials comparing outcomes of triple therapy (dual antiplatelet therapy and anticoagulant) with dual therapy (single antiplatelet therapy and anticoagulant) in patients taking long-term anticoagulants after percutaneous coronary intervention. Major bleeding was the primary outcome. Random effects overall risk ratios (RRs) were calculated using the DerSimonian and Laird model. RESULTS: Nine observational studies and 2 randomized controlled trials with a total of 7276 patients met our selection criteria. At a mean follow-up of 10.8 months major bleeding was higher in the triple therapy cohort compared with dual therapy (6.6% vs 3.8%; RR 1.54; 95% confidence interval [CI], 1.2-1.98; P <.01). No difference was observed between the 2 groups for all-cause mortality (RR 0.98; 95% CI, 0.68-1.43; P = .93), major adverse cardiac events (RR 1.03; 95% CI, 0.8-1.32; P = .83), thromboembolic events (RR 1.02; 95% CI, 0.49-2.10; P = .96), myocardial infarction (RR 0.85; 95% CI, 0.67-1.09; P = .21), stent thrombosis (RR 0.77; 95% CI, 0.46-1.3; P = .33), and target vessel revascularization (RR 0.87; 95% CI, 0.66-1.15; P = .33). CONCLUSION: In patients receiving anticoagulant therapy, a strategy of single antiplatelet therapy confers a benefit of less major bleeding with no difference in all-cause mortality, cardiovascular mortality, major adverse cardiac events, myocardial infarction, stent thrombosis, or thromboembolic event rate compared with dual antiplatelet therapy.
Authors: Alexander E Sullivan; Michael G Nanna; Sunil V Rao; Sarah Cantrell; C Michael Gibson; Freek W A Verheugt; Eric D Peterson; Renato D Lopes; John H Alexander; Christopher B Granger; Megan K Yee; David F Kong Journal: Catheter Cardiovasc Interv Date: 2019-11-11 Impact factor: 2.692
Authors: Harsh B Golwala; Christopher P Cannon; Ph Gabriel Steg; Gheorghe Doros; Arman Qamar; Stephen G Ellis; Jonas Oldgren; Jurrien M Ten Berg; Takeshi Kimura; Stefan H Hohnloser; Gregory Y H Lip; Deepak L Bhatt Journal: Eur Heart J Date: 2018-05-14 Impact factor: 35.855
Authors: Jonas Oldgren; Philippe Gabriel Steg; Stefan H Hohnloser; Gregory Y H Lip; Takeshi Kimura; Matias Nordaby; Martina Brueckmann; Eva Kleine; Jurrien M Ten Berg; Deepak L Bhatt; Christopher P Cannon Journal: Eur Heart J Date: 2019-05-14 Impact factor: 29.983