Meta-analysis study on direct oral anticoagulants vs warfarin therapy in atrial fibrillation and PCI: Dual or triple approach?
Background: Dual antiplatelet therapy and anticoagulants may be required in the case of coexistence of coronary artery disease and atrial fibrillation (AF) undergoing (PCI), with associated increased bleeding rates. The introduction of direct oral anticoagulants (DOACs), however, significantly reduc...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906720302670 |
| _version_ | 1818305418058792960 |
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| author | Natale Daniele Brunetti Lucia Tricarico Luisa De Gennaro Michele Correale Francesco Santoro Riccardo Ieva Massimo Iacoviello Matteo Di Biase |
| author_facet | Natale Daniele Brunetti Lucia Tricarico Luisa De Gennaro Michele Correale Francesco Santoro Riccardo Ieva Massimo Iacoviello Matteo Di Biase |
| author_sort | Natale Daniele Brunetti |
| collection | DOAJ |
| description | Background: Dual antiplatelet therapy and anticoagulants may be required in the case of coexistence of coronary artery disease and atrial fibrillation (AF) undergoing (PCI), with associated increased bleeding rates. The introduction of direct oral anticoagulants (DOACs), however, significantly reduced the incidence of bleeding complications in this clinical setting of patients. We therefore sought to assess whether the recent publication of the AUGUSTUS and ENTRUST-AF PCI studies significantly impacted current evidence on the use of DOACs in AF patients treated with PCI. Methods: We performed a meta-analysis of randomized controlled studies enrolling patients with nonvalvular AF undergoing PCI. We assessed pooled estimates of risk ratios (RRs) and 95%CIs for any bleeding (AB), cardiovascular events (CVE), and death at follow-up: 12,542 patients have been included in the analysis. We particularly analyzed data comparing dual anti-thrombotic therapy (DOAC plus single anti-platelet therapy) with triple (DOAC plus dual anti-platelet therapy). Results: When compared with patients receiving standard triple therapy with warfarin, patients receiving DOACs had a significantly lower risk of AB (RR 0.65; 95% CI, 0.61–0.70, p < 0.00001) and of MB (RR 0.63; 95% CI, 0.53–0.73, p < 0.00001). The risk of cardiovascular events and mortality were comparable between DOAC and VKA groups (RR 1.05, 95% CI 0.93–1.18, RR 1.14, 95% CI 0.94–1.37, respectively, p n.s.). Similar results were observed comparing triple therapy vs dual therapy. Conclusions: DOACs are safer than and as effective as warfarin when used in patients with AF undergoing PCI; dual therapy with DOACs is comparable to triple therapy in terms of safety and efficacy. |
| first_indexed | 2024-12-13T06:26:16Z |
| format | Article |
| id | doaj.art-a2d47103952f4bf8bcd6590993007021 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-13T06:26:16Z |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-a2d47103952f4bf8bcd65909930070212022-12-21T23:56:44ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672020-08-0129100569Meta-analysis study on direct oral anticoagulants vs warfarin therapy in atrial fibrillation and PCI: Dual or triple approach?Natale Daniele Brunetti0Lucia Tricarico1Luisa De Gennaro2Michele Correale3Francesco Santoro4Riccardo Ieva5Massimo Iacoviello6Matteo Di Biase7Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy; Corresponding author.Department of Medical & Surgical Sciences, University of Foggia, Foggia, ItalyCardiology Department, San Paolo Hospital, Bari, ItalyOspedali Riuniti University Hospital, Foggia, ItalyDepartment of Medical & Surgical Sciences, University of Foggia, Foggia, ItalyOspedali Riuniti University Hospital, Foggia, ItalyDepartment of Medical & Surgical Sciences, University of Foggia, Foggia, ItalyDepartment of Medical & Surgical Sciences, University of Foggia, Foggia, ItalyBackground: Dual antiplatelet therapy and anticoagulants may be required in the case of coexistence of coronary artery disease and atrial fibrillation (AF) undergoing (PCI), with associated increased bleeding rates. The introduction of direct oral anticoagulants (DOACs), however, significantly reduced the incidence of bleeding complications in this clinical setting of patients. We therefore sought to assess whether the recent publication of the AUGUSTUS and ENTRUST-AF PCI studies significantly impacted current evidence on the use of DOACs in AF patients treated with PCI. Methods: We performed a meta-analysis of randomized controlled studies enrolling patients with nonvalvular AF undergoing PCI. We assessed pooled estimates of risk ratios (RRs) and 95%CIs for any bleeding (AB), cardiovascular events (CVE), and death at follow-up: 12,542 patients have been included in the analysis. We particularly analyzed data comparing dual anti-thrombotic therapy (DOAC plus single anti-platelet therapy) with triple (DOAC plus dual anti-platelet therapy). Results: When compared with patients receiving standard triple therapy with warfarin, patients receiving DOACs had a significantly lower risk of AB (RR 0.65; 95% CI, 0.61–0.70, p < 0.00001) and of MB (RR 0.63; 95% CI, 0.53–0.73, p < 0.00001). The risk of cardiovascular events and mortality were comparable between DOAC and VKA groups (RR 1.05, 95% CI 0.93–1.18, RR 1.14, 95% CI 0.94–1.37, respectively, p n.s.). Similar results were observed comparing triple therapy vs dual therapy. Conclusions: DOACs are safer than and as effective as warfarin when used in patients with AF undergoing PCI; dual therapy with DOACs is comparable to triple therapy in terms of safety and efficacy.http://www.sciencedirect.com/science/article/pii/S2352906720302670Direct anticoagulantsVitamin-K inhibitorsDual and triple therapyMeta-analysisAtrial fibrillationCoronary angioplasty |
| spellingShingle | Natale Daniele Brunetti Lucia Tricarico Luisa De Gennaro Michele Correale Francesco Santoro Riccardo Ieva Massimo Iacoviello Matteo Di Biase Meta-analysis study on direct oral anticoagulants vs warfarin therapy in atrial fibrillation and PCI: Dual or triple approach? International Journal of Cardiology: Heart & Vasculature Direct anticoagulants Vitamin-K inhibitors Dual and triple therapy Meta-analysis Atrial fibrillation Coronary angioplasty |
| title | Meta-analysis study on direct oral anticoagulants vs warfarin therapy in atrial fibrillation and PCI: Dual or triple approach? |
| title_full | Meta-analysis study on direct oral anticoagulants vs warfarin therapy in atrial fibrillation and PCI: Dual or triple approach? |
| title_fullStr | Meta-analysis study on direct oral anticoagulants vs warfarin therapy in atrial fibrillation and PCI: Dual or triple approach? |
| title_full_unstemmed | Meta-analysis study on direct oral anticoagulants vs warfarin therapy in atrial fibrillation and PCI: Dual or triple approach? |
| title_short | Meta-analysis study on direct oral anticoagulants vs warfarin therapy in atrial fibrillation and PCI: Dual or triple approach? |
| title_sort | meta analysis study on direct oral anticoagulants vs warfarin therapy in atrial fibrillation and pci dual or triple approach |
| topic | Direct anticoagulants Vitamin-K inhibitors Dual and triple therapy Meta-analysis Atrial fibrillation Coronary angioplasty |
| url | http://www.sciencedirect.com/science/article/pii/S2352906720302670 |
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