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Dual anti-thrombotic treatment with direct anticoagulants improves clinical outcomes in patients with Atrial Fibrillation with ACS or undergoing PCI. A systematic review and meta-analysis

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  • Salvatore De Rosa
  • Jolanda Sabatino
  • Alberto Polimeni
  • Sabato Sorrentino
  • Ciro Indolfi

Abstract

Background: There is recent new evidence regarding the combined use of direct oral antiocoagulants and antiplatelet agents in patients with Atrial Fibrillation undergoing PCI. Purpose: To compare the efficacy of dual antithrombotic treatment (DAT) including a direct oral anticoagulant (DOAC) and an antiplatelet agent versus triple antithrombotic treatment (TAT) with a vitamin K antagonist (VKA). Data sources: PubMed, SCOPUS and Google Scholar from through 09/09/2019; references of eligible studies; relevant scientific sessions abstracts and cardiology websites. Study selection: Randomized controlled trials that compared DAT including a DOAC with TAT including a VKA and that reported at least the rates of stroke, Stent thrombosis and bleeding. Data extraction: Two investigators independently extracted study data and assessed study quality. Data synthesis: Four randomized trials that compared DAT including a DOAC with TAT including a VKA were available. Among these, one trial included two independent treatment arms with different DOAC dose, both compared against TAT. For this reason, the two arms were treated independently, resulting in 5 randomized comparisons available for meta-analysis, with a total of 8654 patients involved. The primary safety endpoint was significantly lower in the DAT arm (14.4%) compared to the TAT arm (23%) (RD = -0.08; p

Suggested Citation

  • Salvatore De Rosa & Jolanda Sabatino & Alberto Polimeni & Sabato Sorrentino & Ciro Indolfi, 2020. "Dual anti-thrombotic treatment with direct anticoagulants improves clinical outcomes in patients with Atrial Fibrillation with ACS or undergoing PCI. A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-11, July.
    • Handle: RePEc:plo:pone00:0235511
    DOI: 10.1371/journal.pone.0235511
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    References listed on IDEAS

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    1. Jeffrey C. Valentine & Therese D. Pigott & Hannah R. Rothstein, 2010. "How Many Studies Do You Need?," Journal of Educational and Behavioral Statistics, , vol. 35(2), pages 215-247, April.
    2. Giuseppe Santarpia & Salvatore De Rosa & Alberto Polimeni & Salvatore Giampà & Mariella Micieli & Antonio Curcio & Ciro Indolfi, 2015. "Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants versus Vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Radiofrequency Catheter Ablation of Atrial Fibrillation: A Me," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-18, May.
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