Brunetti Natale Daniele, Tricarico Lucia, De Gennaro Luisa, Correale Michele, Santoro Francesco, Ieva Riccardo, Iacoviello Massimo, Di Biase Matteo
Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy.
Cardiology Department, San Paolo Hospital, Bari, Italy.
Int J Cardiol Heart Vasc. 2020 Jun 28;29:100569. doi: 10.1016/j.ijcha.2020.100569. eCollection 2020 Aug.
Dual antiplatelet therapy and anticoagulants may be required in the case of coexistence of coronary artery disease and atrial fibrillation (AF) undergoing (PCI), with associated increased bleeding rates. The introduction of direct oral anticoagulants (DOACs), however, significantly reduced the incidence of bleeding complications in this clinical setting of patients. We therefore sought to assess whether the recent publication of the AUGUSTUS and ENTRUST-AF PCI studies significantly impacted current evidence on the use of DOACs in AF patients treated with PCI.
We performed a meta-analysis of randomized controlled studies enrolling patients with nonvalvular AF undergoing PCI. We assessed pooled estimates of risk ratios (RRs) and 95%CIs for any bleeding (AB), cardiovascular events (CVE), and death at follow-up: 12,542 patients have been included in the analysis. We particularly analyzed data comparing dual anti-thrombotic therapy (DOAC plus single anti-platelet therapy) with triple (DOAC plus dual anti-platelet therapy).
When compared with patients receiving standard triple therapy with warfarin, patients receiving DOACs had a significantly lower risk of AB (RR 0.65; 95% CI, 0.61-0.70, p < 0.00001) and of MB (RR 0.63; 95% CI, 0.53-0.73, p < 0.00001). The risk of cardiovascular events and mortality were comparable between DOAC and VKA groups (RR 1.05, 95% CI 0.93-1.18, RR 1.14, 95% CI 0.94-1.37, respectively, p n.s.). Similar results were observed comparing triple therapy vs dual therapy.
DOACs are safer than and as effective as warfarin when used in patients with AF undergoing PCI; dual therapy with DOACs is comparable to triple therapy in terms of safety and efficacy.
对于接受经皮冠状动脉介入治疗（PCI）的冠心病合并心房颤动（AF）患者，可能需要双重抗血小板治疗和抗凝治疗，这会导致出血率增加。然而，直接口服抗凝剂（DOACs）的引入显著降低了该临床环境下患者出血并发症的发生率。因此，我们试图评估AUGUSTUS和ENTRUST - AF PCI研究的最新发表是否对目前关于DOACs在接受PCI治疗的AF患者中应用的证据产生显著影响。
我们对纳入接受PCI治疗的非瓣膜性AF患者的随机对照研究进行了荟萃分析。我们评估了随访时任何出血（AB）、心血管事件（CVE）和死亡的风险比（RRs）及95%置信区间（CIs）的汇总估计值：1分析纳入了12542例患者。我们特别分析了比较双重抗栓治疗（DOAC加单一抗血小板治疗）与三联治疗（DOAC加双重抗血小板治疗）的数据。
与接受华法林标准三联治疗的患者相比，接受DOACs治疗的患者发生AB的风险显著更低（RR 0.65；95% CI，0.61 - 0.70，p < 0.00001），发生大出血（MB）的风险也显著更低（RR 0.63；95% CI，0.53 - 0.73，p < 0.00001）。DOAC组和维生素K拮抗剂（VKA）组之间的心血管事件风险和死亡率相当（RR分别为1.05，95% CI 0.93 - 1.18；RR为1.14，95% CI 0.94 - 1.37，p无统计学意义）。比较三联治疗与双重治疗时观察到了类似结果。
在接受PCI治疗的AF患者中使用时，DOACs比华法林更安全且疗效相当；DOACs双重治疗在安全性和疗效方面与三联治疗相当。
