Aim To determine the optimum antithrombotic therapy for patients with atrial fibrillation (AF) and coronary artery disease (CAD) requiring percutaneous coronary intervention (PCI) and/or acute coronary syndrome (ACS) regarding the incidence of myocardial infarction or stent thrombosis. Previous meta-analyses have yielded conflicting conclusions. We have therefore performed a comprehensive literature search and performed a meta-analysis of all published RCTs to test the hypothesis that TAT significantly reduces the risk of stent thrombosis (ST) and Myocardial Infarction (MI).
Methods A literature search was done for RCTs on the efficacy of antithrombotic therapy in patients with AF and ACS or PCI.
Results A total of 11,542 patients were included in the 5 RCTs , comparing TAT vs DAT. Triple therapy did not lead to significant reduction in risk of Myocardial Infarction (MI) [risk ratio (RR) 0.85, 95% CI 0.69-1.04, P= 0.12], [figure 1] or Stent Thrombosis (RR 0.76, 95% CI 0.51-1.12 P=0.16). On the other hand, the risk of major bleeding or clinically significant bleeding is significantly lower with DAT [figure 2].
Conclusion In conclusion, DAT comprising of warfarin or DOAC and P2Y12 inhibitor reduced risk of major or clinically significant bleeding without increasing the risk of ST or recurrent MI as compared to TAT. The results encourage the use of DAT rather than TAT in patients with ACS and/or patients requiring PCI with coexistent AF who require combined antiplatelet and anticoagulant therapy.
Conflict of Interest None
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