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Meta-Analysis Comparing Double Versus Triple Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary

Venkatesh Ravi1, Priyanjali Pulipati2, Aviral Vij1

  • 1Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.

The American Journal of Cardiology
|December 16, 2019
PubMed

Insights

Double antithrombotic therapy (DATT) is as effective as triple antithrombotic therapy (TATT) for preventing ischemic events in atrial fibrillation and coronary artery disease patients. DATT significantly reduces major bleeding events compared to TATT.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Atrial fibrillation (AF) and coronary artery disease (CAD) present a significant therapeutic challenge.
  • Balancing antithrombotic therapy to mitigate bleeding versus ischemic risks is crucial.

Purpose of the Study:

  • To conduct a meta-analysis comparing the efficacy and safety of double antithrombotic therapy (DATT) versus triple antithrombotic therapy (TATT).
  • To evaluate outcomes in patients with both AF and CAD.

Main Methods:

  • Searched MEDLINE, Cochrane, and ClinicalTrials.gov databases up to May 1, 2019.
  • Included 9 studies with 6,104 patients on DATT and 7,333 on TATT.
  • Analyzed outcomes including mortality, myocardial infarction, stent thrombosis, stroke, and major bleeding.

Main Results:

  • No significant differences were observed in mortality, nonfatal myocardial infarction, stent thrombosis, or stroke between DATT and TATT.
  • DATT showed a significantly lower rate of major bleeding (RR 0.64; p <0.001).
  • Subgroup analysis of direct oral anticoagulant trials indicated a borderline higher rate of stent thrombosis with DATT (RR 1.66; p = 0.05).

Conclusions:

  • DATT is comparable to TATT regarding mortality, stroke, myocardial infarction, and stent thrombosis in AF and CAD patients.
  • DATT offers a significant reduction in major bleeding events.
  • Further research is needed to clarify the borderline increased stent thrombosis risk with DATT in specific subgroups using direct oral anticoagulants.

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