Journal of Thrombosis and Thrombolysis

, Volume 48, Issue 3, pp 511–513 | Cite as

Dual versus triple therapy for patients with atrial fibrillation and acute coronary syndrome: a meta-analysis and trial sequential analysis of randomized controlled trials

  • Babikir KheiriEmail author
  • Mohammed Osman
  • Ahmed Bakhit
  • Qais Radaideh
  • Ahmed Abdalla
  • Mahmoud Barbarawi
  • Yazan Zayed
  • Sahar Ahmed
  • Ghassan Bachuwa
  • Mustafa Hassan
Letter to the Editor

In patients with acute coronary syndrome (ACS), the incidence of atrial fibrillation (AF) ranges from 10 to 21% and is an independent predictor of poor long-term outcomes including death [1, 2]. The choice of antithrombotic therapy for AF patients with concomitant ACS or patients who have undergone percutaneous coronary intervention (PCI) with coronary stenting is challenging [1]. Dual antiplatelet therapy is indicated to reduce cardiovascular ischemic events including stent thrombosis, and is not proven to protect against AF-related strokes [3]. In contrast, oral anticoagulation is proven to prevent ischemic stroke and systemic embolism in patients with AF but has not been shown to reduce stent thrombosis [3]. However, triple therapy with dual antiplatelets and an anticoagulant increases the risk of bleeding [4]. Therefore, alternative strategies to balance the risk of bleeding and ischemic events in this high-risk population is needed. Although previous trials have shown a...


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Conflicts of interest

The authors declare that they have no conflict of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine, Hurley Medical CenterMichigan State UniversityFlintUSA
  2. 2.Division of CardiologyWest Virginia University School of MedicineMorgantownUSA
  3. 3.Division of CardiologySaint Vincent HospitalWorcesterUSA
  4. 4.Midwest Cardiovascular Research FoundationDavenportUSA
  5. 5.Division of Hematology & OncologySt. John HospitalGrosse Pointe WoodsUSA
  6. 6.Division of Cardiology, Hurley Medical CenterMichigan State UniversityFlintUSA

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