Abstract 4270: Comprehensive Meta-Analysis on Oral Anticoagulants for the Secondary Prevention of Coronary Artery Disease Including more than 50,000 Patients
Recurrent events remain frequent among patients with coronary artery disease (CAD). Several trials have appraised the role of oral anticoaugulants in the secondary prevention of CAD, but with inconclusive results. We thus aimed to assess the efficacy and safety of long-term oral anticoagulant treatment in patients with CAD. Potentially eligible studies were searched systematically. The primary end-point was the occurrence of death, myocardial infarction, or stroke. In addition, we appraised individual components of the primary end-point, as well as the risk of major and minor bleedings. Odds ratios (OR) with 95% confidence intervals were computed according to fixed/random effect methods. A total of 61 randomized controlled trials were retrieved, including 57,983 patients. After a median follow-up of 12 months, oral anticoagulants significantly reduced the risk of death, myocardial infarction or stroke in comparison to control therapy (OR=0.74 [0.65– 0.83], p<0.001), as well as death from all causes (p<0.001), myocardial infarction (p<0.001), and stroke (p<0.001), despite an increase in major (p<0.001) and minor bleedings (p<0.001). Stratification for control therapy showed that benefits were maintained when anticoagulants were compared to placebo or standard therapy without any antithrombotic medication (p0.05), despite significant increases in bleeding rates (p<0.001), whereas significant benefits in terms of reduction of stroke risk occurred when comparing oral anticoagulants versus oral antiplatelet agents alone (p<0.001). Specifically, an International Normalized Ratio (INR) between 2.0 and 3.0 appear critical to minimize bleeding risk and maximize antithrombotic effects. Oral anticoagulants significantly prevent adverse events in patients with established CAD in comparison to standard therapy without any antithrombotic medication. Comparisons of oral antiplatelet agents versus oral anticoagulants alone or oral anticoagulants plus oral antiplatelet agents showed conversely that oral anticoagulant therapy can achieve a favorable risk-benefit balance only in subjects without increased bleeding risk are selected and INR is maintained between 2.0 and 3.0.