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A systematic review of randomized trials comparing double versus triple antithrombotic therapy in patients with

Alexander E Sullivan1, Michael G Nanna1,2, Sunil V Rao1,2

  • 1Section of Cardiovascular Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|November 13, 2019
PubMed

Insights

For atrial fibrillation patients undergoing PCI, double therapy (oral anticoagulation + P2Y12 inhibitor) shows fewer bleeding events than triple therapy. However, triple therapy may reduce stent thrombosis risk.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Optimal antithrombotic therapy for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) remains under investigation.
  • Previous trials lacked power to assess ischemic outcomes in this high-risk population.

Purpose of the Study:

  • To compare the efficacy and safety of double therapy (oral anticoagulation + P2Y12 inhibitor) versus triple therapy (oral anticoagulation + dual antiplatelet therapy) in AF patients undergoing PCI.

Main Methods:

  • A systematic review and meta-analysis of four randomized controlled trials (RCTs) adhering to PRISMA guidelines.
  • Pooled data from 10,238 patients (5,498 on double therapy, 4,740 on triple therapy) to evaluate ischemic and bleeding outcomes.

Main Results:

  • Major adverse cardiovascular events were similar between double and triple therapy groups.
  • Triple therapy was associated with a lower risk of stent thrombosis (NNT=242).
  • Double therapy demonstrated significantly reduced bleeding events, including major bleeding (NNH=16) and intracranial hemorrhages.

Conclusions:

  • Double therapy offers a superior safety profile with less bleeding compared to triple therapy in AF patients post-PCI.
  • A potential trade-off exists, with a possible increased risk of stent thrombosis with double therapy.
Abstract

Keywords:
anticoagulants/antithrombinsantiplatelet therapypercutaneous coronary intervention

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