Safety and Efficacy of Dual Versus Triple Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Managing antithrombotic therapy in patients with coronary intervention and a need for anticoagulation is clinically complex.
• Balancing the risks of thrombosis and bleeding is crucial in this patient population.

Purpose of the Study:

• To compare the safety and efficacy of triple therapy (dual antiplatelet therapy + anticoagulant) versus dual therapy (single antiplatelet therapy + anticoagulant) after percutaneous coronary intervention in patients requiring long-term anticoagulation.
• To evaluate major bleeding as the primary outcome and other thrombotic events as secondary outcomes.

Main Methods:

• A meta-analysis was conducted, including nine observational studies and two randomized controlled trials.
• A total of 7276 patients were analyzed.
• Random effects risk ratios were calculated to compare outcomes between triple and dual therapy groups.

Main Results:

• Major bleeding occurred more frequently in the triple therapy group (6.6%) compared to the dual therapy group (3.8%), with a risk ratio of 1.54 (95% CI, 1.2-1.98; P < .01).
• No significant differences were observed between the groups for all-cause mortality, major adverse cardiac events, thromboembolic events, myocardial infarction, stent thrombosis, or target vessel revascularization.

Conclusions:

• In patients on anticoagulant therapy after percutaneous coronary intervention, a strategy of single antiplatelet therapy in combination with anticoagulation (dual therapy) results in less major bleeding.
• This dual therapy approach does not increase the risk of all-cause mortality, cardiovascular mortality, major adverse cardiac events, myocardial infarction, stent thrombosis, or thromboembolic events compared to triple therapy.