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Research Paper|Volume 12, Issue 13|pp 12930—12942

Efficacy and safety of an antithrombotic regimen for atrial fibrillation patients with acute coronary syndrome or those undergoing percutaneous coronary intervention: a meta-analysis

Wenqin Guo1, Xiehui Chen1, Yunling Hao1, Qiang Liu1, Changnong Peng1, Lingyue Zhao2, Zongming Feng1, Xiaoqing Wang1, Huanjun Ruan1, Lang Li3
  • 1Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
  • 2Department of Ambulatory Surgery, Shenzhen Nanshan District People’s Hospital, Shenzhen, China
  • 3Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
* Equal contribution
Received: November 16, 2019Accepted: May 20, 2020Published: July 1, 2020
https://doi.org/10.18632/aging.103359

Copyright © 2020 Guo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

This study evaluated the benefit of dual therapy in reducing ischemic events in atrial fibrillation (AF) patients presenting with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). We searched PubMed, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing dual and triple therapies (oral anticoagulation plus aspirin and P2Y12 inhibitor) for AF patients with ACS or those undergoing PCI. The composite primary outcome included all-cause death, myocardial infarction (MI), stent thrombosis (ST), or stroke. Relative risk (RR) and the corresponding 95% confidence interval (CI) was used as the measure of effect size. Four RCTs with 10,969 patients were included. Dual therapy had a higher event rate of primary outcome than triple therapy (RR, 1.15; 95%CI, 1.03–1.28; P<0.0001). Dual therapy was associated with significantly higher MI risk, insignificantly higher ST risk, and significantly lower major bleeding risk than triple therapy (RR1.23, 95%CI 1.01–1.49, P = 0.036; RR 1.43, 95 %CI 0.98–2.09, P = 0.064; and RR0.58, 95%CI 0.45–0.76, P<0.0001, respectively). Dual antithrombotic therapy was associated with higher ischemic risk but lower major bleeding risk than triple therapy. The data suggest that antithrombotic regimens should be based on tradeoffs between ischemia and bleeding risk.