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Meta-Analysis Comparing Dual Versus Single Antiplatelet Therapy in Combination With Antithrombotic Therapy in Patients With Atrial Fibrillation Who Underwent Percutaneous Coronary Intervention With Stent Implantation - 17/09/18

Doi : 10.1016/j.amjcard.2018.04.050 
Bowen Lou, MD a, b, c, e, , Xiao Liang, MD, PhD a, b, c, , Yue Wu, MD, PhD a, b, c, Yangyang Deng, MD a, b, c, Bo Zhou, MD, PhD d, Zuyi Yuan, MD, PhD a, b, c, , Jianqing She, MD a, b, c,
a Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710048, PR China 
b Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an 710048, PR China 
c Key Laboratory of Molecular Cardiology, Shaanxi Province, PR China 
d Respiratory Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710048, PR China 
e European Center for Angioscience (ECAS), Department of Vascular Biology&Tumor Angiogenesis, Medical Faculty Mannheim, Heidelberg University, Mannheim 68169, Germany 

Corresponding author: Tel: +86 29 8532-3819; fax: +86 29 8532-3709

Riassunto

The coexistence of atrial fibrillation and coronary artery disease is commonly found in clinical practice. The aim of this meta-analysis is to compare the clinical efficacy and safety of dual versus single antiplatelet therapy in combination with antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention. PubMed, EMBASE and Web of Science databases were systematically evaluated for articles published up to October 31, 2017. The risk ratios (RR) were extracted from each study. Pooled estimates with corresponding 95% confidence intervals (CI) were estimated by a fixed or random-effects model. Eight studies involving a total of 10,861 patients with atrial fibrillation were included in this meta-analysis. Five thousand sixty-six participants received dual antiplatelet therapy together with warfarin or new oral anticoagulation (triple antithrombotic therapy, TT) and 5,795 participants received single antiplatelet therapy together with warfarin or new oral anticoagulation (dual antithrombotic therapy). TT was associated with a significantly higher incidence of all (RR 1.45, p <0.001) and major (RR 1.77, p <0.001) bleeding events, but no difference with regard to stroke, in-stent thrombosis, major adverse cardiovascular events, and all-cause mortality rate. In conclusion, as compared to TT, dual antithrombotic therapy is equally effective in reducing stroke, in-stent thrombosis, major adverse cardiovascular events, and all-cause mortality rate, but shows beneficial effect in reducing overall bleeding incidence in atrial fibrillation patients who underwent percutaneous coronary intervention.

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 This study was supported by Central University Basic Science Foundation of China 1191329724 (Shaanxi, China), National Natural Science Foundation of China 81570406 (Shaanxi, China), the Fundamental Research Funds of the First Affiliated Hospital of Xi'an Jiaotong University 2017QN-25 (Shaanxi, China), and the Natural Science Foundation of Shaanxi province 2017JM8016 (Shaanxi, China).


© 2018  The Author(s). Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 122 - N° 4

P. 604-611 - agosto 2018 Ritorno al numero
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