Meta-Analysis Comparing Oral Anticoagulant Monotherapy Versus Dual Antithrombotic Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease.
Humans
Atrial Fibrillation
/ drug therapy
Coronary Artery Disease
/ drug therapy
Administration, Oral
Anticoagulants
/ therapeutic use
Fibrinolytic Agents
/ therapeutic use
Platelet Aggregation Inhibitors
/ therapeutic use
Drug Therapy, Combination
Treatment Outcome
Hemorrhage
/ chemically induced
Randomized Controlled Trials as Topic
anticoagulant
antiplatelet
atrial fibrillation
coronary artery disease
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Oct 2024
Oct 2024
Historique:
received:
09
09
2024
accepted:
25
09
2024
medline:
7
10
2024
pubmed:
7
10
2024
entrez:
7
10
2024
Statut:
ppublish
Résumé
Oral anticoagulants (OACs) are routinely used for the management of atrial fibrillation (AF) while antiplatelet agents are used in coronary artery disease (CAD). However, data regarding the comparative clinical outcomes of OAC monotherapy versus dual antithrombotic therapy (anticoagulant plus antiplatelet agent) in patients with AF and stable CAD are limited. A comprehensive search of major databases including PubMed/MEDLINE, Cochrane Library, and Embase was performed from inception to September 1, 2024 to identify randomized control trials (RCTs) that compared OAC monotherapy with dual antithrombotic therapy in patients with AF and stable CAD. The risk ratios (RRs) were estimated with corresponding 95% confidence intervals (CIs) for all outcomes. A total of three RCTs reported data for 3945 patients with AF and stable CAD. The mean age of patients was 73.8 (±11.85) years and the mean follow-up was 22 months. OAC monotherapy was associated with a significantly reduced relative risk of major bleeding (RR: 0.55, 95% CI: 0.32-0.95) compared to dual therapy. The risk of all-cause death (RR: 0.85, 95% CI: 0.49-1.48), cardiovascular death (RR: 0.84, 95% CI: 0.50-1.41), any stroke event (RR: 0.74, 95% CI: 0.46-1.18), and myocardial infarction (RR: 1.57, 95% CI: 0.79-3.12) remained comparable across the two groups. OAC monotherapy led to a significant relative risk reduction for major bleeding with similar rates of ischemic events and mortality compared to dual antithrombotic therapy in patients with AF and stable CAD.
Sections du résumé
BACKGROUND
BACKGROUND
Oral anticoagulants (OACs) are routinely used for the management of atrial fibrillation (AF) while antiplatelet agents are used in coronary artery disease (CAD). However, data regarding the comparative clinical outcomes of OAC monotherapy versus dual antithrombotic therapy (anticoagulant plus antiplatelet agent) in patients with AF and stable CAD are limited.
METHODS
METHODS
A comprehensive search of major databases including PubMed/MEDLINE, Cochrane Library, and Embase was performed from inception to September 1, 2024 to identify randomized control trials (RCTs) that compared OAC monotherapy with dual antithrombotic therapy in patients with AF and stable CAD. The risk ratios (RRs) were estimated with corresponding 95% confidence intervals (CIs) for all outcomes.
RESULTS
RESULTS
A total of three RCTs reported data for 3945 patients with AF and stable CAD. The mean age of patients was 73.8 (±11.85) years and the mean follow-up was 22 months. OAC monotherapy was associated with a significantly reduced relative risk of major bleeding (RR: 0.55, 95% CI: 0.32-0.95) compared to dual therapy. The risk of all-cause death (RR: 0.85, 95% CI: 0.49-1.48), cardiovascular death (RR: 0.84, 95% CI: 0.50-1.41), any stroke event (RR: 0.74, 95% CI: 0.46-1.18), and myocardial infarction (RR: 1.57, 95% CI: 0.79-3.12) remained comparable across the two groups.
CONCLUSION
CONCLUSIONS
OAC monotherapy led to a significant relative risk reduction for major bleeding with similar rates of ischemic events and mortality compared to dual antithrombotic therapy in patients with AF and stable CAD.
Substances chimiques
Anticoagulants
0
Fibrinolytic Agents
0
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e70026Subventions
Organisme : The authors received no specific funding for this work.
Informations de copyright
© 2024 The Author(s). Clinical Cardiology published by Wiley Periodicals LLC.
Références
M. Sagris, E. P. Vardas, P. Theofilis, A. S. Antonopoulos, E. Oikonomou, and D. Tousoulis, “Atrial Fibrillation: Pathogenesis, Predisposing Factors, and Genetics,” International Journal of Molecular Sciences 23, no. 1 (December 2021): 6.
D. Capodanno, K. Huber, R. Mehran, et al., “Management of Antithrombotic Therapy in Atrial Fibrillation Patients Undergoing PCI,” Journal of the American College of Cardiology 74, no. 1 (July 2019): 83–99.
J. Mant, F. R. Hobbs, K. Fletcher, et al., “Warfarin Versus Aspirin for Stroke Prevention in an Elderly Community Population With Atrial Fibrillation (The Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): A Randomised Controlled Trial,” Lancet 370, no. 9586 (August 2007): 493–503.
S. J. Connolly, J. Eikelboom, C. Joyner, et al., “Apixaban in Patients With Atrial Fibrillation,” New England Journal of Medicine 364, no. 9 (March 2011): 806–817.
H. Watanabe, T. Domei, T. Morimoto, et al., “Effect of 1‐Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12‐Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI: The STOPDAPT‐2 Randomized Clinical Trial,” JAMA 321, no. 24 (June 2019): 2414–2427.
N. van Rein, U. Heide‐Jørgensen, W. M. Lijfering, O. M. Dekkers, H. T. Sørensen, and S. C. Cannegieter, “Major Bleeding Rates in Atrial Fibrillation Patients on Single, Dual, or Triple Antithrombotic Therapy,” Circulation 139, no. 6 (February 2019): 775–786.
A. Hayek, B. J. MacDonald, G. Marquis‐Gravel, et al., “Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary Artery Disease With Recent or Remote Events: Systematic Review and Meta‐Analysis,” CJC Open 6, no. 5 (May 2024): 708–720.
S. Kawakami, S. Yasuda, and H. Ogawa, “Antithrombotic Therapy in Atrial Fibrillation Patients With Coronary Artery Disease: Shifting Paradigm to a “Less Is More” Concept Regimen,” Journal of Cardiology 76, no. 1 (July 2020): 35–43.
A. Shakir, A. Khan, S. Agarwal, et al., “Dual Therapy With Oral Anticoagulation and Single Antiplatelet Agent Versus Monotherapy With Oral Anticoagulation Alone in Patients With Atrial Fibrillation and Stable Ischemic Heart Disease: A Systematic Review and Meta‐Analysis,” Journal of Interventional Cardiac Electrophysiology 66, no. 2 (March 2023): 493–506.
M. S. Cho, D. Y. Kang, J. M. Ahn, et al., “Edoxaban Antithrombotic Therapy for Atrial Fibrillation and Stable Coronary Artery Disease,” New England Journal of Medicine. Published ahead of print, September 1, 2024, https://doi.org/10.1056/NEJMoa2407362.
M. J. Page, J. E. McKenzie, P. M. Bossuyt, et al., “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” BMJ 372 (March 2021): n71.
J. A. C. Sterne, J. Savović, M. J. Page, et al., “RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials,” BMJ 366 (August 2019): l4898.
N. Mantel and W. Haenszel, “Statistical Aspects of the Analysis of Data From Retrospective Studies of Disease,” Journal of the National Cancer Institute 22, no. 4 (April 1959): 719–748.
R. C. Paule and J. Mandel, “Consensus Values and Weighting Factors,” Journal of Research of the National Bureau of Standards 87, no. 5 (1982): 377–385.
J. J. Deeks, J. P. Higgins, and D. G. Altman, “Analysing Data and Undertaking Meta‐Analyses,” in Cochrane Handbook for Systematic Reviews of Interventions, eds. J. P. T. Higgins, J. Thomas, J. Chandler, M. Cumpston, T. Li, M. J. Page, et al. (Wiley 2019), 241–284, https://doi.org/10.1002/9781119536604.ch10.
S. Yasuda, K. Kaikita, M. Akao, J. Ako, T. Matoba, M. Nakamura, et al., “Antithrombotic Therapy for Atrial Fibrillation With Stable Coronary Disease,” New England Journal of Medicine 381, no. 12 (September 2019): 1103–1113.
Y. Matsumura‐Nakano, S. Shizuta, A. Komasa, et al., “Open‐Label Randomized Trial Comparing Oral Anticoagulation With and Without Single Antiplatelet Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent Implantation,” Circulation 139, no. 5 (January 2019): 604–616.
T. S. Potpara, N. Mujovic, M. Proietti, et al, “Revisiting the Effects of Omitting Aspirin in Combined Antithrombotic Therapies for Atrial Fibrillation and Acute Coronary Syndromes or Percutaneous Coronary Interventions: Meta‐Analysis of Pooled Data From the PIONEER AF‐PCI, RE‐DUAL PCI, and AUGUSTUS trials,” Europace 22, no. 1 (January 2020): 33–46.
R. D. Lopes, H. Hong, R. E. Harskamp, et al., “Safety and Efficacy of Antithrombotic Strategies in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Network Meta‐Analysis of Randomized Controlled Trials,” JAMA Cardiology 4, no. 8 (August 2019): 747–755.
S. Lindahl, R. Dyrkorn, O. Spigset, and S. Hegstad, “Quantification of Apixaban, Dabigatran, Edoxaban, and Rivaroxaban in Human Serum by UHPLC‐MS/MS‐Method Development, Validation, and Application,” Therapeutic Drug Monitoring 40, no. 3 (June 2018): 369–376.
W. W. Nelson, L. Wang, O. Baser, C. V. Damaraju, and J. R. Schein, “Out‐Of‐Range INR Values and Outcomes Among New Warfarin Patients With Non‐Valvular Atrial Fibrillation,” International Journal of Clinical Pharmacy 37, no. 1 (February 2015): 53–59.