Tentu Niharika, Ijaz Aqsa, Batool Saima, Khan Rubba S, Mohammed Fathia, Khan Maryam H, Sandhu Qudsia I, Ali Neelum
Medicine, St. John's Medical College, Bangalore, IND.
Internal Medicine, Allama Iqbal Medical College, Lahore, PAK.
Cureus. 2022 Sep 30;14(9):e29772. doi: 10.7759/cureus.29772. eCollection 2022 Sep.
It is still uncertain whether patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) who require long-term oral anticoagulation (OAC) should also receive antiplatelet treatment (APT). This meta-analysis aims to compare the efficacy and safety of OAC alone with OAC plus APT in individuals with AF and stable CAD. The current meta-analysis was conducted as per the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE). We performed electronic searches using PubMed, EMBASE, and Cochrane Library. The efficacy outcomes assessed in this meta-analysis included cardiovascular death, myocardial infarction, stroke (ischemic and hemorrhagic), and all-cause mortality. The safety outcome included major bleeding events. A total of five studies were included in the current meta-analysis enrolling 9199 patients with stable CAD and AF. Out of these five studies, three were observational and two were randomized controlled trials (RCTs). Our study showed no significant difference between two groups in the incidence of cardiovascular mortality (Hazard ratio {HR}: 0.86, 95% confidence interval {CI}: 0.59-1.25, I-square: 44%), myocardial infarction (HR: 1.21, 95% CI: 0.73-2.01, I-square: 0%), all-cause mortality (HR: 0.95, 95% CI: 0.76-1.19, I-square: 68%) and stroke (HR: 0.83, 95% CI: 0.61-1.12, I-square: 45%). However, lower incidence of major bleeding events in patients who received OAC alone as compared to patients who received a combination of OAC and anti-platelet (HR: 1.37, 95% CI: 1.18-1.580, I-square: 78%) were found. The current meta-analysis showed that OAC monotherapy is associated with a lower incidence of major bleeding events in patients with stable CAD and AF. It is also not associated with an increased risk of all-cause mortality, cardiovascular death, stroke, and myocardial infarction.
对于患有心房颤动（AF）且患有稳定冠状动脉疾病（CAD）并需要长期口服抗凝治疗（OAC）的患者是否也应接受抗血小板治疗（APT），目前仍不确定。本荟萃分析旨在比较单独使用OAC与OAC加APT在AF和稳定CAD患者中的疗效和安全性。当前的荟萃分析是按照系统评价和荟萃分析的首选报告项目（PRISMA）以及流行病学观察性研究的荟萃分析（MOOSE）的指南进行的。我们使用PubMed、EMBASE和Cochrane图书馆进行了电子检索。本荟萃分析评估的疗效结局包括心血管死亡、心肌梗死、中风（缺血性和出血性）以及全因死亡率。安全性结局包括大出血事件。当前的荟萃分析共纳入五项研究，涉及9199例患有稳定CAD和AF的患者。在这五项研究中，三项为观察性研究，两项为随机对照试验（RCT）。我们的研究表明，两组在心血管死亡率（风险比{HR}：0.86，95%置信区间{CI}：0.59 - 1.25，I²：44%）、心肌梗死（HR：1.21，95% CI：0.73 - 2.01，I²：0%）、全因死亡率（HR：0.95，95% CI：0.76 - 1.19，I²：68%）和中风（HR：0.83，95% CI：0.61 - 1.12，I²：45%）的发生率上无显著差异。然而，与接受OAC和抗血小板联合治疗的患者相比，单独接受OAC治疗的患者大出血事件发生率较低（HR：1.37，95% CI：1.18 - 1.580，I²：78%）。当前的荟萃分析表明，OAC单药治疗与稳定CAD和AF患者大出血事件发生率较低相关。它也与全因死亡率、心血管死亡、中风和心肌梗死风险增加无关。
