Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary Artery Disease With Recent or Remote Events: Systematic Review and Meta-analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CJC Open Pub Date : 2024-05-01 DOI:10.1016/j.cjco.2024.01.001
Ahmad Hayek MD , Blair J. MacDonald BA PharmD , Guillaume Marquis-Gravel MD, MSc , Kevin R. Bainey MD, MSc , Samer Mansour MD , Margaret L. Ackman PharmD , Warren J. Cantor MD , Ricky D. Turgeon BSc(Pharm), PharmD
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Abstract

Background

Ongoing debate remains regarding optimal antithrombotic therapy in patients with atrial fibrillation (AF) and coronary artery disease.

Methods

We performed a systematic review and meta-analysis to synthesize randomized controlled trials (RCTs) comparing the following: (i) dual-pathway therapy (DPT; oral anticoagulant [OAC] plus antiplatelet) vs triple therapy (OAC and dual-antiplatelet therapy) after percutaneous coronary intervention (PCI) or acute coronary syndrome (ACS), and (iii) OAC monotherapy vs DPT at least 1 year after PCI or ACS. Following a 2-stage process, we identified systematic reviews published between 2019 and 2022 on these 2 clinical questions, and we updated the most comprehensive search for additional RCTs published up to October 2022. Outcomes of interest were major adverse cardiovascular events (MACE), death, stent thrombosis, and major bleeding. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.

Results

Based on 6 RCTs (n = 10,435), DPT reduced major bleeding (RR 0.62, 95% CI 0.52-0.73) and increased stent thrombosis (RR 1.55, 95% CI 1.02-2.36), vs triple therapy after PCI or medically-managed ACS, with no significant differences in MACE and death. In 2 RCTs (n = 2905), OAC monotherapy reduced major bleeding (RR 0.66, 95% CI 0.49-0.91) vs DPT in AF patients with remote PCI or ACS, with no significant differences in MACE or death.

Conclusions

In patients with AF and coronary artery disease, using less-aggressive antithrombotic treatment (DPT after PCI or ACS, and OAC alone after remote PCI or ACS) reduced major bleeding, with an increase in stent thrombosis with recent PCI. These results support a minimalist yet personalized antithrombotic strategy for these patients.

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心房颤动和冠心病患者近期或远期事件的抗血栓治疗:系统回顾和荟萃分析
背景关于心房颤动(AF)和冠状动脉疾病患者的最佳抗血栓治疗仍存在争论。方法我们进行了一项系统综述和荟萃分析,综合比较了以下随机对照试验(RCT):(i) 经皮冠状动脉介入治疗(PCI)或急性冠状动脉综合征(ACS)后的双途径疗法(DPT;口服抗凝剂 [OAC] 加抗血小板)与三联疗法(OAC 和双抗血小板疗法);(iii) PCI 或 ACS 至少 1 年后的 OAC 单药疗法与 DPT。经过两个阶段,我们确定了 2019 年至 2022 年期间发表的有关这两个临床问题的系统综述,并对截至 2022 年 10 月发表的其他 RCT 进行了最全面的检索更新。我们关注的结果是主要不良心血管事件(MACE)、死亡、支架血栓和大出血。结果基于6项RCT(n = 10,435),与PCI或药物治疗ACS后的三联疗法相比,DPT减少了大出血(RR 0.62,95% CI 0.52-0.73),增加了支架血栓形成(RR 1.55,95% CI 1.02-2.36),但在MACE和死亡方面无显著差异。在 2 项 RCT(n = 2905)中,对于远期 PCI 或 ACS 的房颤患者,OAC 单药与 DPT 相比可减少大出血(RR 0.66,95% CI 0.49-0.91),但在 MACE 或死亡方面无明显差异。这些结果支持对这些患者采取最小化但个性化的抗血栓策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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