Abstract 18102: Safety and Efficacy of Triple versus Dual Anti-Platelet Therapy after Stent Implantation in Patients Requiring Chronic Anticoagulation: a Meta-analysis of Observational Studies
Introduction: The optimal anti-thrombotic strategy for patients requiring chronic anticoagulation and undergoing PCI remains unclear. Dual anti-platelet therapy (DAPT) alone is less effective for stroke prevention, yet triple therapy (TT) (dual anti-platelet plus warfarin) carries increased bleeding risk. We performed a meta-analysis to evaluate the benefits and risks of DAPT versus TT.
Methods: A systematic search of PubMed, EMBASE and Scopus was performed. Studies comparing all-cause mortality between patients using DAPT and TT were selected. Secondary end-points of MI, stent thrombosis, stroke and major bleeding were also evaluated. Pooled effect estimates were calculated using random effects model.
Results: We identified 13 studies (n=14,994) that compared outcomes between TT and DAPT. The mean duration of follow-up ranged from 0.5 to 1.6 years. Indications for anticoagulation included atrial fibrillation (75.6%), prosthetic valve (1.2%), DVT/PE (0.9%), LV clot/prophylaxis (0.6%) and other (21.7%). There were no significant differences in all-cause mortality [pooled RR: 0.90 (0.59-1.35), p=0.60], MI [RR: 1.08 (0.63 - 1.87), p=0.77] or stent thrombosis [RR: 0.80 (0.34 - 1.93), p=0.63] among patients treated with TT, as compared to DAPT. However patients treated with TT had significantly lower risk of stroke [RR: 0.51 (0.28 - 0.91), p=0.02] and a significantly increased risk of major bleeding [RR: 1.55 (1.03 - 2.35), p=0.04]. Furthermore, there was no significant difference in Net adverse cardiovascular events (death, MI, stroke or major bleeding) between TT and DAPT [RR: 1.24 (0.85 - 1.81, p =0.26].
Conclusions: The beneficial effect of TT for stroke reduction is compromised by a relative increased risk of major bleeding. It is important to individualize care when choosing antiplatelet and anticoagulant therapy for patients following stent implantation, with careful consideration of each patient’s individual risk for stroke and major bleeding.
- Antiplatelet drugs
- Percutaneous coronary intervention (PCI)
- Acute coronary syndromes
Author Disclosures: C. Bavishi: None. A. Sawant: None. S. Ather: None. J.E. Tamis-Holland: None.
- © 2014 by American Heart Association, Inc.