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Arrhythmias and sudden death
Review
Direct oral anticoagulants versus standard triple therapy in atrial fibrillation and PCI: meta-analysis
  1. Natale Daniele Brunetti1,
  2. Nicola Tarantino1,
  3. Luisa De Gennaro2,
  4. Michele Correale3,
  5. Francesco Santoro1,4 and
  6. Matteo Di Biase5
  1. 1Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  2. 2Cardiology Department, San Paolo Hospital, Bari, Italy
  3. 3Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
  4. 4Department of Cardiology, Asklepios Klinik Sankt Georg, Hamburg, Germany
  5. 5GVM Care & Research, Santa Maria Hospital, Bari, Italy
  1. Correspondence to Dr Natale Daniele Brunetti; nd.brunetti{at}unifg.it

Abstract

The coexistence of coronary artery disease and atrial fibrillation (AF) in the same individuals raises great concern about the co-treatment with different antithrombotic agents in the case of percutaneous coronary interventions (PCI). The advent of direct oral anticoagulants (DOACs) revolutionised the therapy of AF; less is known, however, about the safety and efficacy of therapy with DOACs in combination with antiplatelet agents after PCI. We performed a meta-analysis of randomized controlled studies enrolling patients with nonvalvular AF undergoing PCI. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for any bleeding (AB), cardiovascular events (CVE), major bleeding (MB), myocardial infarction (MI), and stent thrombosis (ST) at follow-up: 4849 patients have been included in the analysis. When compared with patients receiving standard triple therapy (vitamin-K antagonists plus double antiplatelet therapy [VKAs plus DAPT]), patients receiving DOACs (rivaroxaban/dabigatran plus either one or two antiplatelet agents) had a statistically significant lower risk of AB (RR, 0.66; 95% CI, 0.59–0.75, p<0.00001), as well as of MB (RR, 0.59; 95% CI, 0.47–0.73, p<0.00001). Equivalent efficacy was found about CVE (RR, 1.03; 95% CI, 0.89–1.19, p=0.69), MI (RR, 1.09; 95% CI, 0.81–1.45, p=0.57), while slight although non-statistically significant increased risk of ST was found (RR, 1.46; 95% CI, 0.86–2.48, p=0.16). In conclusion, 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.

  • oral anticoagulants
  • coronary balloon angioplasty
  • atrial fibrillation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2018-000785

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    Footnotes

    • Contributors LDeG and MC retrieved data. MDiB supervised the paper. NDB and FS performed statistical analysis. NDB and NT wrote the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.