Coronary disease & ACSMeta-analysis
Antithrombotic therapy after percutaneous coronary intervention in patients with atrial fibrillation: an individual patient data network meta-analysis
- Individual patient data network meta-analysis of randomised trials
- patient-level
- Cox models stratified by trial
Dual antiplatelet therapy (DAPT) to single antiplatelet therapy (SAPT) transition recommended at 1 (1-3) days with direct oral anticoagulants (DOAC) plus P2Y12 inhibitor and 3 (1-7) days with vitamin K antagonist (VKA) plus SAPT
Authors' conclusion
In patients with AF undergoing PCI, the risk of cardiovascular death, myocardial infarction, or stroke did not significantly differ according to whether patients received a DOAC or VKA, whereas a modest increase in risk with single compared with dual antiplatelet therapy cannot be excluded, given the higher risk of early coronary events. DOACs compared with VKAs reduced the risk of bleeding across all severity grades, including intracranial hemorrhage, whereas omission of a second antiplatelet agent reduced the risk of TIMI major or minor bleeding.
Study context
- Population
- Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI)
- Participants
- 10,634 patients · 6 trials
- Comparison
- DOAC + P2Y12 inhibitor vs VKA + SAPT vs DOAC + DAPT vs VKA + DAPT
- DOAC plus P2Y12 inhibitorn = 4,083
- VKA plus SAPTn = 1,247
- VKA plus DAPTn = 3,715reference
- DOAC plus DAPTn = 1,589
Pooled result
As reported in the abstract
Further pooled results
MI and definite/probable stent thrombosis, 14-day landmark analysis · early phase after PCI
- Increased risk with DOAC plus P2Y12 inhibitor or VKA plus SAPT
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| TIMI major bleeding (primary safety outcome) — DOAC plus P2Y12 inhibitor vs VKA plus DAPT | 0.48 (0.38–0.65) | |
| TIMI major bleeding (primary safety outcome) — DOAC plus P2Y12 inhibitor vs VKA plus SAPT | 0.62 (0.40–0.97) | |
| TIMI major bleeding (primary safety outcome) — DOAC plus P2Y12 inhibitor vs DOAC plus DAPT · borderline reduction | 0.66 (0.44–1.01) | |
| Intracranial hemorrhage | 0.21 (0.07–0.64) | |
| 0.050.21520Hazard ratio (log scale) |
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Summarised from the published abstract; every number is checked against it