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Anti-Thrombotic Therapy Strategies With Long-Term Anticoagulation After Percutaneous Coronary Intervention a Systematic Review and Meta-Analysis

Anti-Thrombotic Therapy Strategies With Long-Term Anticoagulation After Percutaneous Coronary Intervention a Systematic Review and Meta-Analysis

Muhammad Rawala, Waqas Siddiqui, Chikezie Alvarez, Muhammad Khan, Maryam Khan, Syed Hasni, Sandeep Aggarwal, Andrew Kohut Howard Eisen
Circulation (New York, N.Y.), v 138(Suppl 1), 11625
06 Nov 2018
Background Long-term oral anticoagulants (OAC) poses a challenge after percutaneous coronary intervention (PCI) for dual antiplatelet therapy (DAPT) with Aspirin and P2Y12 inhibitors due to increased bleeding risk. We hypothesize that dual anti-thrombotic therapy (DATT) reduces bleeding without increased cardiovascular events. Method We searched MEDLINE and PUBMED from inception to March 01, 2018 for randomized control trials (RCTs) comparing DATT vs. Triple anti-thrombotic therapy (TATT) after PCI. Results We identified 251 citations, of which 4 RCTs and 5,317 patients, (3,039 on DATT vs 2,278 on TATT) were included. Significantly reduced total bleeding in DATT arm, 731 vs. 786, odds ratio [OR] = 0.51, Confidence Interval [CI] = 0.39 – 0.67, p < 0.00001, I = 71 %, (I = 0% without WOEST study), TIIMI major bleeding- 60 in DATT vs 80 in TATT group, OR = 0.56, CI = 0.4 – 0.79, p = 0.0009, I = 0%, and TIIMI minor bleeding- DATT vs TATT group 70 vs 126, OR = 0.43, CI = 0.32 – 0.59, p < 0.00001, I = 0% was observed. There was no difference in the incidence of strokes, myocardial infarction, stent thrombosis, and mortality. A trend towards decreased non-cardiac deaths with DATT was observed, 14 vs 26, OR = 0.55, CI = 0.27 – 1.10, p = 0.09, I = 6%. Conclusions DATT significantly reduces bleeding vs. TATT with no difference in adverse cardiovascular outcomes. TATT is associated with more severe bleeding and a trend towards increased non-cardiac death.
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