Optimal Antithrombotic Regimens for Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention:...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Antithrombotic therapy is crucial for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).
• Balancing antithrombotic treatment to minimize bleeding and ischemic risks is a significant clinical challenge.
• Optimizing antithrombotic strategies is essential for improving outcomes in this high-risk patient population.

Purpose of the Study:

• To conduct an up-to-date network meta-analysis evaluating the safety and efficacy of four antithrombotic regimens.
• To identify the optimal antithrombotic treatment strategy for patients with AF undergoing PCI.

Main Methods:

• A systematic network meta-analysis was performed using data from five randomized controlled trials (N=11,542).
• Bayesian random-effects models were applied following PRISMA guidelines.
• Primary outcomes included Thrombolysis In Myocardial Infarction (TIMI) major bleeding and major adverse cardiovascular events (MACE).

Main Results:

• Regimens discontinuing aspirin showed a significantly lower risk of TIMI major bleeding compared to vitamin K antagonists (VKA) plus dual antiplatelet therapy (DAPT).
• Odds ratios for major bleeding were 0.57 (VKA + P2Y12 inhibitor), 0.69 (non-VKA oral anticoagulant [NOAC] + DAPT), and 0.52 (NOAC + P2Y12 inhibitor).
• No significant differences in major adverse cardiovascular events (MACE) were observed across the evaluated regimens.

Conclusions:

• Antithrombotic regimens including VKA plus DAPT should generally be avoided in patients with AF undergoing PCI.
• Discontinuing aspirin may reduce bleeding risk without compromising antithrombotic effectiveness.
• A NOAC plus a P2Y12 inhibitor, without aspirin, appears to be the most favorable and preferred treatment option for most patients.