Triple versus double antithrombotic therapy in patients with atrial fibrillation and stent implantation. A meta-analysis of randomized trials.

Abstract

BACKGROUND\nAppropriate double and triple antithrombotic therapy in patients with atrial fibrillation and stent implantation is unclear.\n\n\nAIM\nThe aim of the study was to perform a meta- analysis of studies comparing double (DT) vs triple (TT) antithrombotic therapy in patients with atrial fibrillation and stent implantation.\n\n\nMETHODS\nOut of the 450 reports, five randomized trials were qualified for the meta-analysis: WOEST, ISAR-REACT, PIONEER AF-PCI, RE-DUAL PCI and AUGUSTUS. A total of 9,931 patients were included.\n\n\nRESULTS\nTreatment efficacy, as assessed by the incidence of MACE, did not significantly differentiate between both therapeutic strategies; 8.98% DT vs 8.71% TT, (OR = 1.02, 0.86-1.21). The incidence of haemorrhagic complications was significantly lower in patients treated with DT than TT and was 13.1% and 21.0%, respectively, (OR = 0.57 , 0.47-0.70). In over 90% of the subjects, DT, along with oral anticoagulant (NOAC, VKA), included clopidogrel.\n\n\nCONCLUSIONS\nThe results of our meta-analysis are clearly in line with the current trend of the fastest possible reduction in the use of TT in favor of DT. Almost half lower risk of hemorrhagic complications during DT treatment compared to TT with similar efficacy of the two strategies provide arguments for the wider use of DT in patients with AF and stent implantation.