Anti-thrombotic therapy strategies with long-term anticoagulation after percutaneous coronary intervention – a systematic review and meta-analysis
Background: Long-term oral anticoagulants (OAC) increases bleeding risk after the percutaneous coronary intervention (PCI) with dual antiplatelet therapy (DAPT) with Aspirin and P2Y12 inhibitors. We hypothesize that dual anti-thrombotic therapy (DATT) reduces bleeding without increased cardiovascula...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Greater Baltimore Medical Center
2019-05-01
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| Series: | Journal of Community Hospital Internal Medicine Perspectives |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/20009666.2019.1611330 |
| _version_ | 1797967177098199040 |
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| author | 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 Howard Eisen |
| author_facet | 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 Howard Eisen |
| author_sort | Waqas Javed Siddiqui |
| collection | DOAJ |
| description | Background: Long-term oral anticoagulants (OAC) increases bleeding risk after the percutaneous coronary intervention (PCI) with dual antiplatelet therapy (DAPT) with Aspirin and P2Y12 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, I2 = 71% (I2 = 0% without WOEST study)], [TIIMI major bleeding 60 vs. 80, OR = 0.56, CI = 0.4–0.79, p = 0.0009, I2 = 0%], and [TIIMI minor bleeding, 70 vs 126, OR = 0.43, CI = 0.32–0.59, p < 0.00001, I2 = 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, I2 = 6%. Conclusions: DATT is associated with significantly reduced bleeding and a trend towards reduced non-cardiac death with no difference in adverse cardiovascular outcomes. |
| first_indexed | 2024-04-11T02:27:04Z |
| format | Article |
| id | doaj.art-881cd7881e2f48409ff70b342172de2e |
| institution | Directory Open Access Journal |
| issn | 2000-9666 |
| language | English |
| last_indexed | 2024-04-11T02:27:04Z |
| publishDate | 2019-05-01 |
| publisher | Greater Baltimore Medical Center |
| record_format | Article |
| series | Journal of Community Hospital Internal Medicine Perspectives |
| spelling | doaj.art-881cd7881e2f48409ff70b342172de2e2023-01-02T22:37:08ZengGreater Baltimore Medical CenterJournal of Community Hospital Internal Medicine Perspectives2000-96662019-05-019320321010.1080/20009666.2019.16113301611330Anti-thrombotic therapy strategies with long-term anticoagulation after percutaneous coronary intervention – a systematic review and meta-analysisWaqas Javed Siddiqui0Muhammad Yasir Khan1Muhammad Shabbir Rawala2Kadambari Jethwani3Mohammad Harisullah Khan4Chikezie Alvarez5Ramsha Kashif6Syed Farhan Hasni7Sandeep Aggarwal8Andrew Kohut9Howard Eisen10Drexel University College of MedicineCapital Health Regional Medical CenterRapides Regional Medical CenterDrexel University College of MedicineDrexel University College of MedicineSeton Hall University, St. Francis Medical CenterDrexel University College of MedicineDrexel University College of MedicineDrexel University College of MedicineUniversity of PennsylvaniaPenn State Hershey Heart and Vascular InstituteBackground: Long-term oral anticoagulants (OAC) increases bleeding risk after the percutaneous coronary intervention (PCI) with dual antiplatelet therapy (DAPT) with Aspirin and P2Y12 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, I2 = 71% (I2 = 0% without WOEST study)], [TIIMI major bleeding 60 vs. 80, OR = 0.56, CI = 0.4–0.79, p = 0.0009, I2 = 0%], and [TIIMI minor bleeding, 70 vs 126, OR = 0.43, CI = 0.32–0.59, p < 0.00001, I2 = 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, I2 = 6%. Conclusions: DATT is associated with significantly reduced bleeding and a trend towards reduced non-cardiac death with no difference in adverse cardiovascular outcomes.http://dx.doi.org/10.1080/20009666.2019.1611330Oral anticoagulationatrial fibrillationbleedingtriple anti-thrombotic therapydual-anti thrombotic therapy |
| spellingShingle | 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 Howard Eisen Anti-thrombotic therapy strategies with long-term anticoagulation after percutaneous coronary intervention – a systematic review and meta-analysis Journal of Community Hospital Internal Medicine Perspectives Oral anticoagulation atrial fibrillation bleeding triple anti-thrombotic therapy dual-anti thrombotic therapy |
| title | Anti-thrombotic therapy strategies with long-term anticoagulation after percutaneous coronary intervention – a systematic review and meta-analysis |
| title_full | Anti-thrombotic therapy strategies with long-term anticoagulation after percutaneous coronary intervention – a systematic review and meta-analysis |
| title_fullStr | Anti-thrombotic therapy strategies with long-term anticoagulation after percutaneous coronary intervention – a systematic review and meta-analysis |
| title_full_unstemmed | Anti-thrombotic therapy strategies with long-term anticoagulation after percutaneous coronary intervention – a systematic review and meta-analysis |
| title_short | Anti-thrombotic therapy strategies with long-term anticoagulation after percutaneous coronary intervention – a systematic review and meta-analysis |
| title_sort | anti thrombotic therapy strategies with long term anticoagulation after percutaneous coronary intervention a systematic review and meta analysis |
| topic | Oral anticoagulation atrial fibrillation bleeding triple anti-thrombotic therapy dual-anti thrombotic therapy |
| url | http://dx.doi.org/10.1080/20009666.2019.1611330 |
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