Evaluation of the Efficacy and Safety of Dual Antiplatelet Therapy with or Without Warfarin in Patients with a Clinical Indication for DAPT and Chronic Anticoagulation: A Meta-Analysis of Observational Studies
Por:
Bavishi, C, Koulova, A, Bangalore, S, Sawant, A, Chatterjee, S, Ather, S, Valencia J, Sarafoff, N, Rubboli, A, Airaksinen, J, Lip, G and Tamis-Holland, J
Publicada:
1 jul 2016
Resumen:
Objective: To compare the efficacy and safety of dual antiplatelet
therapy (DAPT) and triple therapy (TT, dual antiplatelet plus warfarin)
in patients with myocardial infarction (MI) or PCI with stenting (PCI-S)
who also require chronic oral anticoagulation. Background:
Recommendations for the optimal antiplatelet/anticoagulant treatment
regimen for patients undergoing PCI-S or MI who also require oral
anticoagulation are largely based on evidence from observational studies
and expert opinions. Methods: A systematic search was performed for
studies comparing TT vs. DAPT in patients post PCI-S or MI and requiring
chronic anticoagulation. Primary outcome was all-cause mortality.
Secondary outcomes were ischemic stroke, major bleeding, MI, and stent
thrombosis. Pooled relative risks (RR) were calculated using random
effects model. Results: A total of 17 studies were included, with 14,921
patients [TT: 5,819(39%) and DAPT: 9,102(61%)] and a mean follow-up of
1.6 years. The majority of patients required oral anticoagulation for
atrial fibrillation. Compared to DAPT, patients treated with TT had no
significant difference in all-cause mortality [RR: 0.81, 95% confidence
interval (CI): 0.61-1.08, P = 0.15], MI [RR 0.74, 95% CI: 0.51-1.06, P =
0.10], and stent thrombosis [RR 0.67, 95% CI: 0.35-1.30, P = 0.24].
Patients treated with TT had significantly increased risk of major
bleeding [RR 1.20, 95% CI: 1.03-1.39, P = 0.02], whereas the risk for
ischemic stroke was significantly lower [RR 0.59, 95% CI: 0.38-0.92, P =
0.02]. Conclusions: All-cause mortality appears similar in patients
treated with TT or DAPT although TT was associated with higher rates of
major bleeding and a lower risk for ischemic stroke. (C) 2015 Wiley
Periodicals, Inc.
Filiaciones:
Bavishi, C:
Mt Sinai St Lukes Hosp, New York, NY USA
Mt Sinai Roosevelt Hosp, New York, NY USA
Koulova, A:
Mt Sinai St Lukes Hosp, New York, NY USA
Mt Sinai Roosevelt Hosp, New York, NY USA
Bangalore, S:
NYU, Sch Med, New York, NY USA
Sawant, A:
Mt Sinai St Lukes Hosp, New York, NY USA
Mt Sinai Roosevelt Hosp, New York, NY USA
Chatterjee, S:
Mt Sinai St Lukes Hosp, New York, NY USA
Mt Sinai Roosevelt Hosp, New York, NY USA
Ather, S:
Univ Alabama Birmingham, Birmingham, AL USA
Valencia J:
Hosp Gen Univ Alicante, Alicante, Spain
Sarafoff, N:
Klinikum Ludwig Maximilians Univ, Munich, Germany
Rubboli, A:
Osped Maggiore Bologna, Div Cardiol, Bologna, Italy
Airaksinen, J:
Turku Univ Hosp, Turku, Finland
Univ Turku, Ctr Heart, Turku, Finland
Lip, G:
Univ Birmingham, City Hosp, Ctr Cardiovasc Sci, Dept Clin Med, Birmingham, W Midlands, England
Aalborg Univ, Aalborg Thrombosis Res Unit, Aalborg, Denmark
Tamis-Holland, J:
Mt Sinai St Lukes Hosp, New York, NY USA
Mt Sinai Roosevelt Hosp, New York, NY USA
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