Department of Medicine, UA College of Medicine, University of Arizona Tucson, Tucson, AZ, USA.
Department of Medicine, Abrazo Health Network, Glendale, AZ, USA.
J Investig Med. 2024 Dec;72(8):956-960. doi: 10.1177/10815589241270640. Epub 2024 Aug 28.
Antithrombotic treatment in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) poses a dilemma. We compared outcomes of dual antithrombotic therapy (DAT) (direct oral anticoagulants (DOACs)/warfarin + antiplatelets) vs triple antithrombotic therapy (TAT) (DOACs/warfarin, aspirin, and P2Y12 inhibitor) in this population. Multiple databases were searched from inception to December 17, 2023 to identify randomized controlled trials (RCTs) comparing DAT vs TAT in patients with AF and ACS. Outcomes included major adverse cardiac events (MACE), bleeding events, stroke, stent thrombosis, and myocardial infarction (MI). Relative risk and 95% confidence intervals were estimated with a random-effects model using the inverse-variance technique. We assigned > 50% as an indicator of statistical heterogeneity. -Value <0.05 was considered significant. Ten RCTs comprising 6186 patients on TAT (female 26%, mean age 71 ± 9 years) and 6800 patients on DAT (female 27%, mean age 71 ± 9 years) were included. Patients receiving DAT experienced lower rates of bleeding events compared to those receiving TAT, with relative risks of 0.69 [0.55-0.87] ( < 0.001), 0.65 [0.40-1.06] ( = 0.09), and 0.62 [0.46-0.84] ( < 0.001) for TAT durations of 3, 6, and 12 months, respectively. No difference was seen in the occurrence of MACE, MI, stroke, or stent thrombosis between DAT and TAT across all three durations of TAT. This is the largest pooled analysis comparing TAT to DAT stratified by the duration of antithrombotic therapy. Our results revealed that DAT was associated with reduced bleeding risk despite no difference in other outcomes.
在患有心房颤动 (AF) 和急性冠状动脉综合征 (ACS) 的患者中进行抗血栓治疗存在困境。我们比较了双联抗血栓治疗 (DAT) (直接口服抗凝剂 (DOACs)/华法林+抗血小板治疗) 与三联抗血栓治疗 (TAT) (DOACs/华法林、阿司匹林和 P2Y12 抑制剂) 在该人群中的疗效。从研究开始到 2023 年 12 月 17 日，我们在多个数据库中搜索了比较 AF 和 ACS 患者 DAT 与 TAT 的随机对照试验 (RCT)。主要不良心脏事件 (MACE)、出血事件、卒中和支架血栓形成和心肌梗死 (MI) 是观察终点。使用随机效应模型和逆方差技术，以相对风险和 95%置信区间来评估结果。我们将>50%定义为统计学异质性的指标。-值<0.05 为有统计学意义。纳入了 10 项 RCT，共纳入 6186 例接受 TAT 治疗的患者 (女性占 26%，平均年龄 71±9 岁) 和 6800 例接受 DAT 治疗的患者 (女性占 27%，平均年龄 71±9 岁)。与接受 TAT 治疗的患者相比，接受 DAT 治疗的患者出血事件发生率较低，接受 TAT 治疗 3、6 和 12 个月的患者相对风险分别为 0.69 [0.55-0.87] ( < 0.001)、0.65 [0.40-1.06] ( = 0.09) 和 0.62 [0.46-0.84] ( < 0.001)。在所有 TAT 治疗持续时间内，DAT 与 TAT 在 MACE、MI、卒中和支架血栓形成的发生方面无差异。这是最大的荟萃分析，比较了 TAT 与 DAT，按抗血栓治疗的持续时间分层。我们的结果表明，尽管 DAT 在其他结局方面没有差异，但 DAT 与出血风险降低相关。
