TY - JOUR
T1 - Safety and efficacy of direct oral anticoagulants compared to Vitamin K antagonists postpercutaneous coronary interventions in patients with atrial fibrillation
T2 - A systematic review and meta-analysis
AU - Agasthi, Pradyumna
AU - Lee, Justin Z.
AU - Pujari, Sai Harika
AU - Tseng, Andrew S.
AU - Shipman, Justin
AU - Almader-Douglas, Diana
AU - Ashraf, Hasan
AU - Mookadam, Farouk
AU - Fortuin, Floyd David
AU - Beohar, Nirat
AU - Arsanjani, Reza
AU - Mulpuru, Siva
N1 - Publisher Copyright:
© 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: Atrial fibrillation (AF) and coronary artery disease (CAD) are commonly associated. Cotreatment with multiple antithrombotic agents can increase the risk of bleeding. We sought to evaluate patient-centered outcomes in patients with AF on double therapy with direct oral anticoagulants (DOACs) compared to patients with standard triple therapy, [a vitamin K antagonist (VKA) plus dual antiplatelet therapy]. Methods: We performed a literature search of randomized controlled trials (RCTs) reporting outcomes of patients receiving double therapy with DOACs compared to triple therapy with VKAs in patients with AF undergoing percutaneous coronary intervention (PCI). Patient-centered outcomes were the International Society of Thrombosis and Hemostasis (ISTH) major or clinically relevant nonmajor bleeding (CRNB), all-cause mortality, major adverse cardiovascular events (MACE), stent thrombosis, myocardial infarction, and stroke. Results: Four RCTs (9602 patients) met our inclusion criteria. Compared to VKAs, DOACs were associated with significantly lower ISTH major bleeding/ CRNB (RR: 0.75, 95% CI: 0.67-0.82, P <.00001, I2 = 11%). There were no statistically significant differences in the efficacy outcomes, including myocardial infarction (RR: 0.99, 95% CI :0.79-1.25, P =.96), stent thrombosis (RR: 0.97, 95% CI: 0.6-1.55, P =.89), ischemic stroke (RR: 0.76, 95% CI: 0.5-1.15, P =.19), all-cause mortality (RR: 1.06, 95% CI: 0.85-1.31, P =.61), and MACE (RR: 1.06, 95% CI: 0.91-1.22, P =.97). Conclusion: Compared with triple therapy with VKAS, double therapy with DOACs is associated with a reduced risk of bleeding and is as effective in patients with AF undergoing PCI.
AB - Background: Atrial fibrillation (AF) and coronary artery disease (CAD) are commonly associated. Cotreatment with multiple antithrombotic agents can increase the risk of bleeding. We sought to evaluate patient-centered outcomes in patients with AF on double therapy with direct oral anticoagulants (DOACs) compared to patients with standard triple therapy, [a vitamin K antagonist (VKA) plus dual antiplatelet therapy]. Methods: We performed a literature search of randomized controlled trials (RCTs) reporting outcomes of patients receiving double therapy with DOACs compared to triple therapy with VKAs in patients with AF undergoing percutaneous coronary intervention (PCI). Patient-centered outcomes were the International Society of Thrombosis and Hemostasis (ISTH) major or clinically relevant nonmajor bleeding (CRNB), all-cause mortality, major adverse cardiovascular events (MACE), stent thrombosis, myocardial infarction, and stroke. Results: Four RCTs (9602 patients) met our inclusion criteria. Compared to VKAs, DOACs were associated with significantly lower ISTH major bleeding/ CRNB (RR: 0.75, 95% CI: 0.67-0.82, P <.00001, I2 = 11%). There were no statistically significant differences in the efficacy outcomes, including myocardial infarction (RR: 0.99, 95% CI :0.79-1.25, P =.96), stent thrombosis (RR: 0.97, 95% CI: 0.6-1.55, P =.89), ischemic stroke (RR: 0.76, 95% CI: 0.5-1.15, P =.19), all-cause mortality (RR: 1.06, 95% CI: 0.85-1.31, P =.61), and MACE (RR: 1.06, 95% CI: 0.91-1.22, P =.97). Conclusion: Compared with triple therapy with VKAS, double therapy with DOACs is associated with a reduced risk of bleeding and is as effective in patients with AF undergoing PCI.
KW - atrial fibrillation
KW - direct oral anticoagulants
KW - percutaneous coronary intervention
KW - vitamin K antagonists
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U2 - 10.1002/joa3.12292
DO - 10.1002/joa3.12292
M3 - Article
AN - SCOPUS:85077847052
SN - 1880-4276
VL - 36
SP - 271
EP - 279
JO - journal of arrhythmia
JF - journal of arrhythmia
IS - 2
ER -