The fading role of triple therapy in patients with atrial fibrillation and acute coronary syndrome: a Bayesian network meta-analysis
The management of patients with concomitant atrial fibrillation (AF) and acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) represents a medical dilemma. Recent US guidelines recommend dual therapy (DT) with non-vitamin K antagonist oral anticoagulants (NOACs) and P2Y12 inhibitor instead of triple therapy (TT) which includes aspirin . To date there is no head-to-head comparison among NOACs with respect to bleeding and ischemic events when utilized in AF patients with ACS and/or PCI. We used the advanced meta-analytic properties of Bayesian analysis to compare different dual therapy regimen including apixaban, rivaroxaban, dabigatran, warfarin among each other and to TT with warfarin. We used study level data and pooled the primary safety outcome of bleeding (as defined by the included trial) and the primary efficacy outcome of major adverse cardiovascular events (composite of cardiac death, stent thrombosis, stroke and myocardial infarction) from available...
- 1.January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA (2019) AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the american college of Cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society. J Am Coll Cardiol. https://doi.org/10.1016/j.jacc.2019.01.011.Google Scholar
- 3.Dewilde WJ, Oirbans T, Verheugt FW, Kelder JC, De Smet BJ, Herrman JP et al (2013) Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet (London, England) 381(9872):1107–1115CrossRefGoogle Scholar
- 4.Gibson CM, Mehran R, Bode C, Halperin J, Verheugt F, Wildgoose P et al (2015) An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI). Am Heart J 169(4):472-8.e5CrossRefGoogle Scholar
- 5.Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, Goodman SG, Windecker S, Darius H, Li J, Averkov O Bahit MC, Berwanger O, Budaj A, Hijazi Z, Parkhomenko A, Sinnaeve P, Storey RF, Thiele H, Vinereanu D, Granger CB, Alexander JH (2019) Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. New Engl J Med 380(16):1509–1524CrossRefGoogle Scholar
- 6.Lip GY, Collet JP, Haude M, Byrne R, Chung EH, Fauchier L, Halvorsen S, Lau D, Lopez-Cabanillas N, Lettino M, Marin (2019) 2018 joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: a joint consensus document of the European Heart Rhythm Association (EHRA), European Society of Cardiology Working Group on Thrombosis, European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA). Europace 21(2):192–193CrossRefGoogle Scholar