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Open Access Journal Article

Dual compared with triple antithrombotics treatment effect on ischemia and bleeding in atrial fibrillation following percutaneous coronary intervention: A meta-analysis

by Marina Emad 1 ,  Hasnaa Osama 1 ,  Hoda Rabea 1  and  Haitham Saeed 1
1
Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
*
Author to whom correspondence should be addressed.
IJCMR  2023, 10; 1(2), 10; https://doi.org/10.61466/ijcmr1020010
Received: 4 August 2023 / Accepted: 26 September 2023 / Published Online: 28 September 2023
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Abstract

Background:

We performed a meta-analysis to evaluate the effects of dual antithrombotic treatment (DATT) including direct oral anticoagulants (OAs) versus triple antithrombotic (TAT) with vitamin K antagonist on bleeding and ischemic results in atrial fibrillation (AF) after percutaneous coronary intervention.

Methods:

A systematic literature search up to April 2021 was done and 5 studies included 8019 subjects with AF using antithrombotic treatment after percutaneous coronary intervention at the start of the study; 4325 of them were using DATT and 3694 were using TATs. They were reporting relationships between the effects of DATT including direct OAs versus TAT with vitamin K antagonist on bleeding and ischemic results in AF after percutaneous coronary intervention. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effects of DATT including direct OAs versus TAT with vitamin K antagonist on bleeding and ischemic results in AF after percutaneous coronary intervention using the dichotomous method with a random or fixed-effect model.

Results:

Dual antithrombotics had significantly lower major bleeding (OR, 0.58; 95% CI, 0.51-0.66, p<0.001), and thrombolysis in myocardial infarction major and minor bleeding (OR, 0.49; 95% CI, 0.36-0.67, p<0.001) compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention.

However, antithrombotics had no significantly difference in all-cause mortality (OR, 1.08; 95% CI, 0.88-1.33, p=0.46), cardiovascular mortality (OR, 1.07; 95% CI, 0.83-1.38, p=0.63), myocardial infarction (OR, 1.16; 95% CI, 0.92-1.46, p=0.01), stent thrombosis (OR, 1.42; 95% CI, 0.94-2.12., p=0.09), and stroke (OR, 0.86; 95% CI, 0.59-1.25, p=0.42) compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention.

Conclusions:

Dual antithrombotics may have a lower risk of major bleeding, and thrombolysis in myocardial infarction major and minor bleeding compared to TATs in subjects with AF using antithrombotic treatment after percutaneous coronary intervention. However, antithrombotics had no significant difference in all-cause mortality, cardiovascular mortality, myocardial infarction, stent thrombosis, and stroke compared to TATs in subjects with AF using antithrombotics treatment after percutaneous coronary intervention. Furthers studies are required to validate these findings.

Keywords: dual antithrombotics; TATs; bleeding; ischemia; atrial fibrillation; percutaneous coronary intervention;
Copyright: © 2023 by Emad, Osama, Rabea and Saeed. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (Creative Commons Attribution 4.0 International License). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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ACS Style
Emad, M.; Osama, H.; Rabea, H.; Saeed, H. Dual compared with triple antithrombotics treatment effect on ischemia and bleeding in atrial fibrillation following percutaneous coronary intervention: A meta-analysis. International Journal of Clinical Medical Research, 2023, 1, 10. https://doi.org/10.61466/ijcmr1020010
AMA Style
Emad M, Osama H, Rabea H, Saeed H. Dual compared with triple antithrombotics treatment effect on ischemia and bleeding in atrial fibrillation following percutaneous coronary intervention: A meta-analysis. International Journal of Clinical Medical Research; 2023, 1(2):10. https://doi.org/10.61466/ijcmr1020010
Chicago/Turabian Style
Emad, Marina; Osama, Hasnaa; Rabea, Hoda; Saeed, Haitham 2023. "Dual compared with triple antithrombotics treatment effect on ischemia and bleeding in atrial fibrillation following percutaneous coronary intervention: A meta-analysis" International Journal of Clinical Medical Research 1, no.2:10. https://doi.org/10.61466/ijcmr1020010

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