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Antithrombotic therapy strategies for atrial fibrillation patients undergoing percutaneous coronary intervention: A

Xiaoxuan Gong1, Shaowen Tang2, Jiangjin Li1

  • 1Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, People's Republic of China.

Plos One
|October 13, 2017
PubMed

Insights

For atrial fibrillation patients undergoing percutaneous coronary intervention, vitamin K antagonist plus single antiplatelet therapy is safest. Rivaroxaban plus dual antiplatelet therapy is a potential alternative.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) require antithrombotic therapy.
  • Balancing the risk of thromboembolic events and bleeding is crucial in this population.
  • Comparative efficacy and safety data for various antithrombotic regimens are essential for clinical decision-making.

Purpose of the Study:

  • To systematically review and perform a network meta-analysis on the comparative efficacy and safety of antiplatelet agents, vitamin K antagonists (VKAs), and non-VKA oral anticoagulants (NOACs).
  • To evaluate these antithrombotic strategies in patients with AF undergoing PCI.

Main Methods:

  • A comprehensive search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted.
  • Included were clinical trials with at least 12 months of follow-up comparing antiplatelet drugs with VKAs and NOACs or their combinations in AF patients undergoing PCI.
  • A Bayesian random-effects model was used for network meta-analysis, presenting results as relative risks (RRs) and 95% confidence intervals (CIs).

Main Results:

  • Fifteen studies involving 13,104 patients were analyzed.
  • Rivaroxaban 15 mg daily plus a P2Y12 inhibitor showed superiority in reducing thromboembolic events compared to dual- and triple-antiplatelet therapies (DAPT, TT).
  • Vitamin K antagonist plus single antiplatelet therapy (SAPT) appeared safest, while rivaroxaban regimens presented a higher major bleeding risk. DAPT showed significantly less major bleeding than TT.

Conclusions:

  • Combination therapy with vitamin K antagonist and single antiplatelet therapy is recommended as the optimal choice for AF patients undergoing PCI, balancing efficacy and safety.
  • Rivaroxaban 2.5 mg twice daily plus DAPT is identified as the most probable optimal alternative to VKA plus SAPT for this patient group.
Abstract

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