Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
J Cardiovasc Pharmacol. 2021 Feb 1;77(2):164-169. doi: 10.1097/FJC.0000000000000938.
Clinical trials have assessed the effect of direct oral antagonists (DOACs) in patients with atrial fibrillation (AF) after percutaneous coronary interventions (PCI). Studies were designed to test the effect on bleeding incidence, but concerns related to safety on ischemic events remain.
We performed a meta-analysis with currently available studies involving DOACs versus Vitamin-K antagonist (VKA) in patients with AF after PCI. The primary endpoint was the incidence of cardiac ischemic events, including myocardial infarction and stent thrombosis. Secondary endpoints were the incidence of stroke, all-cause mortality, and major bleeding.
Eleven thousand twenty-three patients were included in the analysis: 5510 receiving DOACs and 5513 VKA. A total of 190 cases of myocardial infarction were registered in patients treated with DOACs and 177 in patients on VKA, and no statistical difference was noted [relative risk (RR): 1.07 95% confidence interval (CI) 0.88-1.31]. The incidence of stent thrombosis was very low with no differences between both treatment strategies (RR: 1.14 95% CI 0.76-1.71). The incidence of cardiac ischemic events was the same in patients receiving DOACs or VKA (HR 1.09 95% CI 0.91-1.30). No differences were observed in the incidence of stroke (RR: 0.86 95% CI 0.61-1.23) or mortality (RR: 1.09, 95% CI 0.90-1.31). Treatment with DOACs was associated with 34% reduction in major bleeding (RR: 0.66, 95% CI 0.54-0.81).
Treatment with DOACs in patients with AF after a PCI do not increase the risk of cardiac ischemic events, stroke, or death and reduce the incidence of major bleeding by 34% as compared with VKA.
临床试验评估了直接口服抗凝剂（DOAC）在经皮冠状动脉介入治疗（PCI）后的心房颤动（AF）患者中的作用。这些研究旨在测试对出血发生率的影响，但与缺血事件相关的安全性问题仍然存在。
我们对涉及 DOAC 与维生素 K 拮抗剂（VKA）在 PCI 后 AF 患者中的现有研究进行了荟萃分析。主要终点是心脏缺血事件的发生率，包括心肌梗死和支架血栓形成。次要终点是卒中、全因死亡率和大出血的发生率。
共有 11023 例患者纳入分析：5510 例接受 DOAC 治疗，5513 例接受 VKA 治疗。在接受 DOAC 治疗的患者中，共有 190 例心肌梗死，在接受 VKA 治疗的患者中，有 177 例心肌梗死，无统计学差异[相对风险（RR）：1.07；95%置信区间（CI）：0.88-1.31]。两种治疗策略之间支架血栓形成的发生率均较低（RR：1.14；95%CI：0.76-1.71）。接受 DOAC 或 VKA 治疗的患者发生心脏缺血事件的发生率相同（HR：1.09；95%CI：0.91-1.30）。在卒中发生率（RR：0.86；95%CI：0.61-1.23）或死亡率（RR：1.09；95%CI：0.90-1.31）方面无差异。与 VKA 相比，DOAC 治疗可使大出血的发生率降低 34%（RR：0.66；95%CI：0.54-0.81）。
与 VKA 相比，在 PCI 后 AF 患者中使用 DOAC 治疗不会增加心脏缺血事件、卒中或死亡的风险，并可降低 34%的大出血发生率。
