Cargando…
Safety and Efficacy of Double Antithrombotic Therapy With Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis
BACKGROUND: The optimal antithrombotic therapy for patients with atrial fibrillation undergoing percutaneous coronary intervention is a topic of debate. We aimed at defining the efficacy and safety of double antithrombotic therapy with single antiplatelet therapy (SAPT) plus a non–vitamin K antagoni...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660808/ https://www.ncbi.nlm.nih.gov/pubmed/32805186 http://dx.doi.org/10.1161/JAHA.120.017212 |
_version_ | 1783609086589272064 |
---|---|
author | Capodanno, Davide Di Maio, Marco Greco, Antonio Bhatt, Deepak L. Gibson, C. Michael Goette, Andreas Lopes, Renato D. Mehran, Roxana Vranckx, Pascal Angiolillo, Dominick J. |
author_facet | Capodanno, Davide Di Maio, Marco Greco, Antonio Bhatt, Deepak L. Gibson, C. Michael Goette, Andreas Lopes, Renato D. Mehran, Roxana Vranckx, Pascal Angiolillo, Dominick J. |
author_sort | Capodanno, Davide |
collection | PubMed |
description | BACKGROUND: The optimal antithrombotic therapy for patients with atrial fibrillation undergoing percutaneous coronary intervention is a topic of debate. We aimed at defining the efficacy and safety of double antithrombotic therapy with single antiplatelet therapy (SAPT) plus a non–vitamin K antagonist oral anticoagulant (NOAC) against triple antithrombotic therapy with dual antiplatelet therapy (DAPT) added to a vitamin K antagonist (VKA), illustrating the pooled cumulative distribution of events, the ranking of different NOACs tested in NOAC+SAPT combination strategies, and the state of the current evidence in the field. METHODS AND RESULTS: Randomized controlled trials meeting the inclusion criteria were identified. The primary efficacy end point was the composite of trial‐defined major adverse cardiac events. The primary safety end point was clinically significant bleeding. Secondary end points were the components of primary end points. Trial‐level pairwise and Bayesian network meta‐analyses, reconstructed Kaplan–Meier analyses, and trial sequential analysis were performed. Four randomized controlled trials (10 969 patients) were included. No differences were found in terms of major adverse cardiac events (hazard ratio [HR], 1.07; 95% CI, 0.94–1.22), and the NOAC+SAPT strategy showed a lower rate of clinically significant bleeding compared with VKA + DAPT (HR, 0.56; 95% CI, 0.39–0.80). These results were consistent in reconstructed Kaplan–Meier analyses. In the Bayesian network meta‐analysis, different NOACs displayed diverse risk–benefit profiles. Trial sequential analyses suggest that the evidence for the similarity in major adverse cardiac events compared with VKA + DAPT and the bleeding risk reduction observed with NOAC+SAPT is likely to be conclusive. CONCLUSIONS: NOAC+SAPT does not increase the risk of major adverse cardiac events and reduces the risk of bleeding compared with VKA + DAPT in AF patients undergoing percutaneous coronary intervention. Various NOACs may have different risk–benefit profiles in combination strategies. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020151089. |
format | Online Article Text |
id | pubmed-7660808 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-76608082020-11-17 Safety and Efficacy of Double Antithrombotic Therapy With Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis Capodanno, Davide Di Maio, Marco Greco, Antonio Bhatt, Deepak L. Gibson, C. Michael Goette, Andreas Lopes, Renato D. Mehran, Roxana Vranckx, Pascal Angiolillo, Dominick J. J Am Heart Assoc Systematic Review and Meta‐analysis BACKGROUND: The optimal antithrombotic therapy for patients with atrial fibrillation undergoing percutaneous coronary intervention is a topic of debate. We aimed at defining the efficacy and safety of double antithrombotic therapy with single antiplatelet therapy (SAPT) plus a non–vitamin K antagonist oral anticoagulant (NOAC) against triple antithrombotic therapy with dual antiplatelet therapy (DAPT) added to a vitamin K antagonist (VKA), illustrating the pooled cumulative distribution of events, the ranking of different NOACs tested in NOAC+SAPT combination strategies, and the state of the current evidence in the field. METHODS AND RESULTS: Randomized controlled trials meeting the inclusion criteria were identified. The primary efficacy end point was the composite of trial‐defined major adverse cardiac events. The primary safety end point was clinically significant bleeding. Secondary end points were the components of primary end points. Trial‐level pairwise and Bayesian network meta‐analyses, reconstructed Kaplan–Meier analyses, and trial sequential analysis were performed. Four randomized controlled trials (10 969 patients) were included. No differences were found in terms of major adverse cardiac events (hazard ratio [HR], 1.07; 95% CI, 0.94–1.22), and the NOAC+SAPT strategy showed a lower rate of clinically significant bleeding compared with VKA + DAPT (HR, 0.56; 95% CI, 0.39–0.80). These results were consistent in reconstructed Kaplan–Meier analyses. In the Bayesian network meta‐analysis, different NOACs displayed diverse risk–benefit profiles. Trial sequential analyses suggest that the evidence for the similarity in major adverse cardiac events compared with VKA + DAPT and the bleeding risk reduction observed with NOAC+SAPT is likely to be conclusive. CONCLUSIONS: NOAC+SAPT does not increase the risk of major adverse cardiac events and reduces the risk of bleeding compared with VKA + DAPT in AF patients undergoing percutaneous coronary intervention. Various NOACs may have different risk–benefit profiles in combination strategies. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020151089. John Wiley and Sons Inc. 2020-08-01 /pmc/articles/PMC7660808/ /pubmed/32805186 http://dx.doi.org/10.1161/JAHA.120.017212 Text en © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Systematic Review and Meta‐analysis Capodanno, Davide Di Maio, Marco Greco, Antonio Bhatt, Deepak L. Gibson, C. Michael Goette, Andreas Lopes, Renato D. Mehran, Roxana Vranckx, Pascal Angiolillo, Dominick J. Safety and Efficacy of Double Antithrombotic Therapy With Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis |
title | Safety and Efficacy of Double Antithrombotic Therapy With Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis |
title_full | Safety and Efficacy of Double Antithrombotic Therapy With Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis |
title_fullStr | Safety and Efficacy of Double Antithrombotic Therapy With Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis |
title_full_unstemmed | Safety and Efficacy of Double Antithrombotic Therapy With Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis |
title_short | Safety and Efficacy of Double Antithrombotic Therapy With Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis |
title_sort | safety and efficacy of double antithrombotic therapy with non–vitamin k antagonist oral anticoagulants in patients with atrial fibrillation undergoing percutaneous coronary intervention: a systematic review and meta‐analysis |
topic | Systematic Review and Meta‐analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660808/ https://www.ncbi.nlm.nih.gov/pubmed/32805186 http://dx.doi.org/10.1161/JAHA.120.017212 |
work_keys_str_mv | AT capodannodavide safetyandefficacyofdoubleantithrombotictherapywithnonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysis AT dimaiomarco safetyandefficacyofdoubleantithrombotictherapywithnonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysis AT grecoantonio safetyandefficacyofdoubleantithrombotictherapywithnonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysis AT bhattdeepakl safetyandefficacyofdoubleantithrombotictherapywithnonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysis AT gibsoncmichael safetyandefficacyofdoubleantithrombotictherapywithnonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysis AT goetteandreas safetyandefficacyofdoubleantithrombotictherapywithnonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysis AT lopesrenatod safetyandefficacyofdoubleantithrombotictherapywithnonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysis AT mehranroxana safetyandefficacyofdoubleantithrombotictherapywithnonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysis AT vranckxpascal safetyandefficacyofdoubleantithrombotictherapywithnonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysis AT angiolillodominickj safetyandefficacyofdoubleantithrombotictherapywithnonvitaminkantagonistoralanticoagulantsinpatientswithatrialfibrillationundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysis |