Efficacy And Safety Of Anticoagulation Strategies In Patients With AF Complicated With CHD Undergoing PCI:Meta Analysis

Background: The choice of anticoagulant strategies after percutaneous coronary intervention(PCI)in patients with atrial fibrillation(AF)and coronary heart disease(CHD)remains controversial.Dual anticoagulants therapy(DAT)or triple anticoagulants therapy(TAT),including or excluding aspirin combined with oral anticoagulants and P2Y12 receptor inhibitors,are the two commonly used anticoagulantion strategies for AF patients with CHD undergoing PCI.We compared the efficacy and safety of DAT,called OAC combined weith P2Y12 receptor inhibitor,with TAT,which OAC combined with dual antiplatelet(DAPT)in CHD patients with AF undergoing PCI.Objective: To compare the efficacy and safety of anticoagulation therapy of DAT and TAT in CHD patients with AF undergoing PCI through meta analysis.Methods: Present meta analysis was performed according to search results,of the patient with AF and CHD undergoing PCI,from Pub Med,Web of Science,Cochrane library,VIP database,Wanfang database and CNKI database.We use relative risk(RR)and 95%confidence interval(95%CI)by software Revman5.3to analysis evaluate effectiveness from all-cause mortality,cardiovascular death,ischemic stroke,myocardial infarction(MI),atent thrombosis and major adverse cardiovascular events(MACE),and analysis evaluate security from bleeding events and intracranial hemorrhage.Result: a total of 6 literatures were included,including 4 randomized controlled trials(RCT),1 prospective controlled trial and 1 retrospective controlled trial.A total of 14948 cases were included,including 6139 cases in the DAT group and8809 cases in the TAT group.There were no statistical differences in all-cause mortality events(RR: 1.19,95%CI: 0.92-1.29,P>0.05),cardiovascular mortality events(RR: 1.13,95%CI: 0.84-1.52,P>0.05),intracranial hemorrhage(RR: 0.97,95%CI: 0.55-1.74,P>0.05),ischemic stroke(RR: 1.05,95%CI: 0.77-1.43),MI(RR: 1.22,95%CI: 1.00-1.49,P=0.05)between the two groups.In terms of the incidence of bleeding events,the DAT group was significantly lower than the TAT group(RR: 0.74,95%CI: 0.62,0.88,P<0.05).For stent thromblsis(RR: 1.58,95%CI: 1.05-2.36,P<0.05)and MACE(RR: 1.20,95%CI: 1.08,1.33,P<0.05),the DAT group had a higher incidence than the TAT group.Concluions: In terms of the anticoagulant strategy for CHD patients with AF undergoing PCI,the DAT group showed no difference from the TAT group in terms of all-cause mortality events,cardiovascular mortality events,intracranial hemorrhage,MI and ischemic stroke.Bleeding events sighificantly reduced the incidence of bleeding events,but increased the risk of stent thrombosis and MACE.