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Anti-thrombotic therapy strategies with long-term anticoagulation after percutaneous coronary intervention - a systematic review and meta-analysis
Journal article   Open access   Peer reviewed

Anti-thrombotic therapy strategies with long-term anticoagulation after percutaneous coronary intervention - a systematic review and meta-analysis

Waqas Javed Siddiqui, Muhammad Yasir Khan, Muhammad Shabbir Rawala, Kadambari Jethwani, Mohammad Harisullah Khan, Chikezie Alvarez, Ramsha Kashif, Syed Farhan Hasni, Sandeep Aggarwal, Andrew Kohut, …
Journal of community hospital internal medicine perspectives, v 9(3)
04 May 2019
DOI: https://doi.org/10.1080/20009666.2019.1611330
PMID: 31258858
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://www.tandfonline.com/doi/pdf/10.1080/20009666.2019.1611330?needAccess=trueView
Published, Version of Record (VoR) Open
url
https://doi.org/10.1080/20009666.2019.1611330View
Published, Version of Record (VoR) Open

Abstract

atrial fibrillation bleeding dual-anti thrombotic therapy Oral anticoagulation triple anti-thrombotic therapy
Background: Long-term oral anticoagulants (OAC) increases bleeding risk after the percutaneous coronary intervention (PCI) with dual antiplatelet therapy (DAPT) with Aspirin and P2Y 12 inhibitors. We hypothesize that dual anti-thrombotic therapy (DATT) reduces bleeding without increased cardiovascular events. Objectives: DATT does not increase adverse cardiovascular events compared to triple anti-thrombotic therapy (TATT). Method: We searched MEDLINE, PUBMED, Google Scholar, Cochrane and EMBASE from inception to 6 April 2019 for randomized control trials (RCTs) comparing DATT to TATT after PCI. Results: We identified 641 citations (411 after excluding duplicates). Four RCTs with 5,317 patients (3,039 on DATT vs 2,278 on TATT) were included. DATT arm showed significantly reduced [total bleeding, 731 vs. 784, odds ratio [OR] = 0.51, Confidence Interval [CI] = 0.39-0.67, p < 0.00001, I 2 = 71% (I 2 = 0% without WOEST study)], [TIIMI major bleeding 60 vs. 80, OR = 0.56, CI = 0.4-0.79, p = 0.0009, I 2 = 0%], and [TIIMI minor bleeding, 70 vs 126, OR = 0.43, CI = 0.32-0.59, p < 0.00001, I 2 = 0%]. There was no difference in subsequent 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 2 = 6%. Conclusions: DATT is associated with significantly reduced bleeding and a trend towards reduced non-cardiac death with no difference in adverse cardiovascular outcomes.

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
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