Cavallari I, et al. - This study was designed to look at the comparative safety and efficacy of dual vs triple antithrombotic therapy in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI). Researchers concluded that dual vs triple antithrombotic therapy afforded bleeding attenuation, without an excess in thromboembolic and ischemic cardiac events, in patients with long-term indication to oral anticoagulation after PCI.

Methods

• Researchers performed this study-level meta-analysis including 4 controlled randomized trials and 6,036 patients with a clinical indication to chronic oral anticoagulation (OAC) after PCI, primarily for AF.
• They compared patients receiving dual therapy with a single antiplatelet agent, essentially a P2Y₁₂ inhibitor, plus OAC to those treated with triple therapy (aspirin, a P2Y₁₂ inhibitor and OAC).
• They assessed the incidence of TIMI major and minor bleeding, MI, stent thrombosis, stroke, cardiovascular and all-cause death.

Results

• Findings demonstrated significantly lower occurrence of TIMI major bleeding in patients treated with dual therapy: 1.97% vs 3.53% in those on triple therapy (OR 0.55, 95% CI 0.39-0.78, p=0.0007); rates of minor bleeding were also decreased in the former (57% relative reduction).
• Researchers observed no statistically significant difference in all-cause and cardiovascular mortality with dual therapy (3.81% vs 4.01%, p=0.37 and 1.62% vs 2.02%, p=0.42, respectively).
• In addition, they noted that both treatment strategies were similar in terms of the incidence of MI (3.25% vs 2.78%, p=0.61), definite stent thrombosis (0.92% vs 0.66%, p=0.46) and stroke (1.28% vs 1.32%, p=0.85).