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

Ravi, Venkatesh; Pulipati, Priyanjali; Vij, Aviral; Kodumuri, Vamsi

doi:10.1016/j.amjcard.2019.09.045

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…This is in view of results from pivotal trials such as WOEST, ISAR‐TRIPLE, and PIONEER‐AF‐PCI which demonstrated that dual therapy (SAPT and OAC) was associated with reduction in major bleeding events with similar efficacy, when compared to triple therapy (DAPT and OAC) 21–23 . This is supported by the recent meta‐analysis which showed no significant increase in mortality, stroke, nonfatal MI, stent thrombosis, and a lower risk of bleeding with dual therapy, compared with triple therapy in AF‐CAD patients 24 …”

Section: Discussionmentioning

confidence: 76%

Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

Kotalczyk

Guo

Fawzy

et al. 2022

Journal of Arrhythmia

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Background Atrial fibrillation (AF) and coronary artery disease (CAD) are closely related; CAD may precede or complicate the clinical course of AF. Objective To evaluate the impact of CAD on clinical outcomes among elderly Chinese AF patients. Methods The ChiOTEAF registry is a prospective registry conducted in 44 sites from 20 provinces in China between October 2014 and December 2018. Primary outcome was the composite of all‐cause mortality/any thromboembolism (TE)/major bleeding/acute coronary syndrome (ACS). Results The eligible cohort for this analysis included 6403 individuals (mean age 74.8 ± 10.7; 39.2% female); of these, 3058 (47.8%) had a history of CAD. On multivariate analysis, CAD was independently associated with a higher odds ratio for ACS (OR: 1.98; 95% CI: 1.12–3.52) without a significant impact on other adverse outcomes. Independent variables associated with the composite outcome among CAD patients were: (i) the use of OAC (OR: 0.55; 95% CI: 0.42–0.72), age (OR: 1.09; 95% CI: 1.08–1.11), heart failure (OR: 1.95; 95% CI: 1.51–2.50), prior ischemic stroke (OR: 1.29; 95% CI: 1.02–1.64), chronic kidney disease (OR: 1.71; 95% CI: 1.32–2.22), and chronic obstructive pulmonary disease (OR: 1.42; 95% CI: 1.06–1.89). Conclusions AF patients with CAD were at an increased risk of developing ACS but there was no significant difference in the composite outcome, all cause death, cardiovascular death, thromboembolic events or major bleeding compared to the non‐CAD group. OAC use was inversely associated with adverse events, yet their uptake was poor in the AF‐CAD population.

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Section: Discussionmentioning

confidence: 76%

Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

Kotalczyk

Guo

Fawzy

et al. 2022

Journal of Arrhythmia

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“…[ 27 ] In addition, according to a comprehensive meta-analysis, Ravi V. et al suggested the potential increase in the risk of stent thrombosis when choosing DAT in patients with AF and CAD, especially for those at a higher risk of ischemic events. [ 28 ] Our longitudinal cohort study showed the prescription of DAT decreased from 14.3 to 10.5%. In cohort 2, only 4.7% of patients received DAT with SAPT plus full-dose NOAC at discharge, like the regimen recommended by clinical trials.…”

Section: Discussionmentioning

confidence: 95%

Changes of antithrombotic prescription in atrial fibrillation patients with acute coronary syndrome or percutaneous coronary intervention and the subsequent impact on long-term outcomes: a longitudinal cohort study

et al. 2021

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Objectives The choice of optimal antithrombotic therapy in atrial fibrillation (AF) patients with acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) remains controversial. The aim of this longitudinal cohort study is to investigate the prescribing pattern of antithrombotic regimen in different cohorts and its subsequent impact. Setting and design Longitudinal data from the Tri-Service General Hospital-Coronary Heart Disease (TSGH-CHD) registry, between January 2016 and August 2018 was screened. Participants and method Patients with prior history of nonvalvular AF, who had ACS presentation or underwent PCI were selected, and these patients were divided into cohort 1 and cohort 2, according to the index date of antithrombotic prescription before and after the PIONEER AF-PCI study. Primary and secondary outcomes The primary safety endpoints were composites of major bleeding and/or clinically relevant non-major bleeding. The secondary efficacy endpoints included the occurrence of all-cause mortality, stroke/systemic embolization, nonfatal myocardial infarction (MI), and >30-days coronary revascularization. Results A total of 121 patients were included into analysis (cohort 1=35; cohort 2=86). Comparing with cohort 1, the prescription rate of triple antithrombotic therapy (TAT) increased from 17.1 to 38.4%, especially the regimen with dual antiplatelet therapy (DAPT) plus low-dose non-vitamin-K dependent oral anticoagulation (NOAC). However, the prescription rate of dual antithrombotic therapy (DAT) decreased (14.3–10.5%), as well as the prescription rate of DAPT (68.6–51.2%). These changes of antithrombotic prescription across different cohorts were not associated with risk of adverse safety (HR= 0.87; 95% CI, 0.42-1.80, p=0.710) and efficacy outcomes (HR=0.96; 95% CI, 0.40-2.32, p=0.930). Conclusions Entering the NOAC era, the prescription of TAT increased alongside the decrease in DAT. As the prescription rate of DAPT without anticoagulation remained high, future efforts are mandatory to improve the implementation of guidelines and clinical practice.

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“…При этом врач должен комбинировать лекарственные препараты так грамотно и на такой срок, чтобы это позволило избежать развития кровотечения. Двойная антитромбоцитарная терапия снижает частоту риска кровотечений [6], рецидивирующих ишемических событий и тромбоза стента, но малоэффективна в снижении частоты кардиоэмболического инсульта, связанного с ФП [7] и без добавления ОАК применяться не должна. Трехкомпонентная терапия обеспечивает снижение риска ТЭО и ишемических событий, но значимо увеличивает число геморрагических осложнений, поэтому при преобладании риска развития ишемических осложнений ее длительность составляет от 1 до 6 мес., а при высоких рисках кровотечения -до 1 мес., после чего пациенту назначается двухкомпонентная терапия, которая должна включать антиагрегант и антикоагулянт [8].…”

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Changes in prescribing antithrombotic therapy in patients with atrial fibrillation and myocardial infarction in 2016-2019

et al. 2020

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АТТ-антитромботическая терапия, ДАТ-двойная антиагрегантная терапия, ИМ-инфаркт миокарда, ОАК-оральные антикоагулянты, СД-сахарный диабет, ТЭО-тромбоэмболические осложнения, ФП-фибрилляция предсердий, ФР-фактор риска.

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

Cited by 7 publications

References 27 publications

Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

Outcomes in elderly Chinese patients with atrial fibrillation and coronary artery disease. A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

Changes of antithrombotic prescription in atrial fibrillation patients with acute coronary syndrome or percutaneous coronary intervention and the subsequent impact on long-term outcomes: a longitudinal cohort study

Changes in prescribing antithrombotic therapy in patients with atrial fibrillation and myocardial infarction in 2016-2019

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