Takeaway
- Meta-analysis reported that dual antithrombotic therapy has comparable efficacy and better safety vs triple antithrombotic therapy in patients with Afib undergoing percutaneous coronary intervention (PCI).
Why this matters
- Future studies should focus on the most appropriate combination for dual antithrombotic therapy which strikes the right balance between thromboembolic events and risk for bleeding.
Study design
- Meta-analysis of 4 randomised controlled trials including 5317 patients with Afib following PCI received dual or triple antithrombotic therapy.
- Primary efficacy outcome: trial-defined major adverse cardiac events (MACEs).
- Primary safety outcome: Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding.
- Secondary safety outcome: Intracranial bleeding.
- Funding: Baim Clinical Research Institute.
Key results
- Patients receiving dual antithrombotic therapy showed significant reduction in TIMI major or minor bleeding vs those in the triple antithrombotic therapy group (4.3% vs 9.0%; HR, 0.53; 95% credible interval [CrI], 0.36-0.85).
- Risk for intracranial bleeding was similar for both therapies (HR, 0.58; 95% CrI, 0.23-1.49).
- No significant difference was observed between dual and triple antithrombotic therapy in terms of:
- MACE (HR, 0.85; 95% CrI, 0.48-1.29).
- All-cause mortality (HR, 0.85; 95% CrI, 0.46-1.37).
- Cardiac death (HR, 0.89; 95% CrI, 0.41-1.54).
- Myocardial infarction (HR, 1.07; 95% CrI, 0.58-1.95).
- Stent thrombosis (HR, 1.00; 95% CrI, 0.32-2.82).
- Stroke (HR, 0.94; 95% CrI, 0.45-1.84).
Limitations
- Patient level data was not available.
- Heterogeneity existed in trial designs and antiplatelet/antithrombotic therapy used.
References
References
