Antithrombotic Strategies in Patients with Atrial Fibrillation Following Percutaneous Coronary Intervention: A Systemic Review and Network Meta-Analysis of Randomized Controlled Trials

Up to 10% of patients with atrial fibrillation (AF) undergo percutaneous coronary intervention (PCI). A systematic review and network meta-analysis were conducted by searching PubMed, Embase, and the Cochrane database of systematic reviews for randomized control trials that studied the safety and ef...

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Bibliographic Details
Published in:Journal of clinical medicine 2020-04, Vol.9 (4), p.1062
Main Authors: Chua, Su-Kiat, Chen, Lung-Ching, Shyu, Kou-Gi, Cheng, Jun-Jack, Hung, Huei-Fong, Chiu, Chiung-Zuan, Lin, Chiu-Mei
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Angioplasty
Anticoagulants
Aspirin
Bias
Cardiac arrhythmia
Cardiovascular disease
Clinical medicine
Clinical trials
Heart attacks
Hemorrhage
Markov analysis
Meta-analysis
Stroke
Thrombosis
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Summary:Up to 10% of patients with atrial fibrillation (AF) undergo percutaneous coronary intervention (PCI). A systematic review and network meta-analysis were conducted by searching PubMed, Embase, and the Cochrane database of systematic reviews for randomized control trials that studied the safety and efficacy of different antithrombotic strategies in these patients. Six studies, including 12,158 patients were included. Compared to that in the triple antithrombotic therapy group (vitamin K antagonist (VKA) plus P2Y inhibitor and aspirin), thrombolysis in myocardial infarction (TIMI) major bleeding was significantly reduced in the dual antithrombotic therapy (non-vitamin K oral anticoagulants (NOACs) plus P2Y inhibitor) group by 47% (Odds ratio (OR), 0.53; 95% credible interval [CrI], 0.35-0.78; I = 0%). Besides, NOAC plus a P2Y inhibitor was associated with less intracranial hemorrhage compared to VKA plus single antiplatelet therapy (OR: 0.20, 95% CrI: 0.05-0.77). There was no significant difference in the trial-defined major adverse cardiac events or the individual outcomes of all-cause mortality, cardiovascular death, myocardial infarction, stroke or stent thrombosis among all antithrombotic strategies. In conclusion, antithrombotic strategy of NOACs plus P2Y inhibitor is safer than, and as effective as, the strategies including aspirin when used in AF patients undergoing PCI.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm9041062