Department of Pharmacy Services, UK HealthCare, University of Kentucky College of Pharmacy, 800 Rose Street, H110, Lexington, KY, 40536, USA.
Department of Pharmacy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Am J Cardiovasc Drugs. 2018 Dec;18(6):441-455. doi: 10.1007/s40256-018-0287-y.
We set out to synthesize available data on antithrombotic strategies for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), with a focus on triple antithrombotic therapy (triple therapy [TT]; dual antiplatelet therapy plus an anticoagulant) versus dual therapy (DT; one antiplatelet agent and an anticoagulant). We searched OVID MEDLINE and PubMed from January 2005 to September 2017 using the search terms oral anticoagulant, triple therapy, dual therapy, acute coronary syndrome, percutaneous coronary intervention, and atrial fibrillation (limited to randomized controlled trials, observational studies, English language, minimum 6-12 months of follow-up, minimum 100 human patients). We excluded surveys, literature reviews, articles not directly related to TT versus DT, incomplete studies, and short-term in-hospital studies. All eligible studies were reviewed to evaluate possible antithrombotic management strategies for patients with AF undergoing PCI. Extracted studies were categorized according to the specific anticoagulant (vitamin K antagonist vs. direct-acting oral anticoagulant) and P2Y inhibitor used. Each category review was followed by a discussion providing insight into the quality of evidence and implications for practice. We found that the risk of bleeding with TT was higher than with DT, without demonstrated added benefit of reducing major adverse cardiovascular events. TT use should be minimized in patients with high bleeding risk, and patient-specific factors should be critically analyzed to select appropriate antiplatelet and anticoagulant agents.
我们旨在综合现有的关于接受经皮冠状动脉介入治疗（PCI）的心房颤动（AF）患者抗栓策略的数据，重点关注三联抗栓治疗（TT；双重抗血小板治疗加抗凝剂）与双联抗栓治疗（DT；一种抗血小板药物加抗凝剂）。我们使用口服抗凝剂、三联治疗、双联治疗、急性冠状动脉综合征、经皮冠状动脉介入治疗和心房颤动（仅限于随机对照试验、观察性研究、英语、随访至少 6-12 个月、至少 100 例人类患者）等术语，在 OVID MEDLINE 和 PubMed 中进行了搜索。我们排除了调查、文献综述、与 TT 与 DT 无关的文章、不完整的研究和短期住院研究。所有符合条件的研究都进行了回顾，以评估接受 PCI 的 AF 患者的可能抗栓管理策略。根据使用的具体抗凝剂（维生素 K 拮抗剂与直接作用的口服抗凝剂）和 P2Y 抑制剂，对提取的研究进行了分类。对每个分类进行了综述，并讨论了对证据质量和对实践的影响。我们发现 TT 的出血风险高于 DT，但并未证明其在减少主要不良心血管事件方面有额外获益。TT 的使用应在高出血风险患者中最小化，并且应仔细分析患者的具体因素，以选择合适的抗血小板和抗凝药物。
