Increased Major Bleeding Complications Related to Triple Antithrombotic Therapy Usage in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Artery Stenting

Manzano‐Fernández, Sergio; Pastor, Francisco; Marı́n, Francisco; Cambronero, Francisco; Caro, César; Pascual-Figal, Domingo A.; Garrido, Iris P.; Pinar, Eduardo; Valdés, Mariano; Lip, Gregory Y.H.

doi:10.1378/chest.08-0350

Cited by 115 publications

(78 citation statements)

References 28 publications

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“…From 625 initial citations, 16 eligible studies including a total of 9185 patients were identified in the present meta‐analysis,4, 5, 6, 7, 12, 14, 15, 19, 20, 21, 22, 23, 24, 25, 26, 27 with 5680 patients in the triple therapy group and 3505 in the dual therapy group (Figure 1). …”

Section: Resultsmentioning

confidence: 99%

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Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta‐analysis of 16 Clinical Trials and 9185 Patients

Gao

Chen

Fan

et al. 2015

Clinical Cardiology

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The optimal antithrombotic regimen remains controversial in patients taking oral anticoagulation (OAC) undergoing coronary stenting. This study sought to compare efficacy and safety outcomes of triple therapy (OAC, aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or OAC) in these patients. We hypothesize OAC plus clopidogrel could be the optimal regimen for patients with indications for OAC receiving stent implantation. Medline, the Cochrane Library, and other Internet sources were searched for clinical trials comparing the efficacy and safety of triple vs dual therapy for patients taking OAC after coronary stenting. Sixteen eligible trials including 9185 patients were identified. The risks of major adverse cardiac events (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.82‐1.39, P = 0.65), all‐cause mortality (OR: 0.98, 95% CI: 0.76‐1.27, P = 0.89), myocardial infarction (OR: 1.01, 95% CI: 0.77‐1.31, P = 0.97), and stent thrombosis (OR: 0.91, 95% CI: 0.49‐1.69, P = 0.75) were similar between triple and dual therapy. Compared with dual therapy, triple therapy was associated with a reduced risk of ischemic stroke (OR: 0.57, 95% CI: 0.35‐0.94, P = 0.03) but with higher major bleeding (OR: 1.52, 95% CI: 1.11‐2.10, P = 0.01) and minor bleeding (OR: 1.59, 95% CI: 1.05‐2.42, P = 0.03). Subgroup analysis indicated there were similar ischemic stroke and major bleeding outcomes between triple therapy and therapy with OAC plus clopidogrel. Treatment with OAC and clopidogrel was associated with similar efficacy and safety outcomes compared with triple therapy. Triple therapy could be replaced by OAC plus clopidogrel without any concern about additional risk of thrombotic events.

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Section: Resultsmentioning

confidence: 99%

“…Finally, 12 studies were identified in the DAPT subgroup,4, 5, 6, 7, 19, 20, 21, 22, 23, 24, 25, 26 with the other 4 studies included in the OAC/C subgroup 12, 14, 15, 27…”

Section: Resultsmentioning

confidence: 99%

Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta‐analysis of 16 Clinical Trials and 9185 Patients

Gao

Chen

Fan

et al. 2015

Clinical Cardiology

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“…Специальных исследований, посвященных дифференцированной оценке различных ти-пов кровотечений при тройной антитромбо-тической терапии, не так много, но все они свидетельствуют о повышении как общего числа кровотечений, так и больших ГО на фо-не тройной антитромботической терапии [48][49][50][51][52][53][54][55][56][57].…”

Section: Discussionunclassified

“…Присоединение одного и двух антиагреган-тов к терапии варфарином приводит к увели-чению суммарной частоты больших и клини-чески значимых ГО, что согласуется с работа-ми других авторов [7,[48][49][50][51][52][53][54][55][56][57]. При этом было выявлено, что это увеличение в основном обу-словлено ростом клинически значимых ГО, но небольших кровотечений.…”

Section: Discussionunclassified

“…Тройная ан-титромботическая терапия (сочетание варфа-рина с двумя антиагрегантами) достоверно по-вышала риск развития ЖКК в 3 раза. Получен-ные нами результаты согласуются с данными других авторов: продемонстрировано увеличе-ние риска кровотечений из верхних и нижних отделов ЖКТ на фоне присоединения антиаг-регантов к варфарину [49][50][51][52][53].…”

Section: Discussionunclassified

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SAFETY OF LONG-TERM THERAPY WITH WARFARIN: HEMORRHAGE FREQUENCY AND CLINICAL PREDICTORS (results of a prospective 15-year follow-up)

et al. 2017

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Risk of Bleeding With Single, Dual, or Triple Therapy With Warfarin, Aspirin, and Clopidogrel in Patients With Atrial Fibrillation

Hansen¹,

Sørensen²,

Clausen³

et al. 2010

Arch Intern Med

755

464

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Increased Major Bleeding Complications Related to Triple Antithrombotic Therapy Usage in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Artery Stenting

Cited by 115 publications

References 28 publications

Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta‐analysis of 16 Clinical Trials and 9185 Patients

Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta‐analysis of 16 Clinical Trials and 9185 Patients

SAFETY OF LONG-TERM THERAPY WITH WARFARIN: HEMORRHAGE FREQUENCY AND CLINICAL PREDICTORS (results of a prospective 15-year follow-up)

Risk of Bleeding With Single, Dual, or Triple Therapy With Warfarin, Aspirin, and Clopidogrel in Patients With Atrial Fibrillation

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