Evaluation Of Antithrombotic Therapies After Pci In Patients With An Indication For Chromnic Oral Anticoagulation:a Meta-Analysis

Introduction:There is still no consensus on the optimal antithrombotic strategy for patients with chronic oral anticoagulation (OAC) after percutaneous coronary intervention (PCI). This meta-analysis aimed to evaluate the safety and efficacy of triple antithrombotic therapy (TT, asprin+clopidogrel+warfarin) compared with dual antiplatlet therapy (DAPT, asprin+clopidogrel) and double therapy (clopidogrel+warfarin).Methods and Results:A literature search was performed and yielded a total of 18 trials (16 covered TT versus DAPT,6 covered TT versus double therapy). As for the comparison of TT and DAPT, there was a trend towards a lower incidence of stroke in TT group (OR,0.66; 95% CI,0.41-1.09; p=0.10), but when restricting to non-Asian studies, a significant reduction of stroke risk was observed in TT group (OR,0.49; 95% CI,0.35-0.67; p<0.00001).The incidence of stent thrombosis was comparable between TT and DAPT (OR,1.07; 95% CI,0.42-2.77; p=0.88).There was a significant rise in major bleeding (OR,1.54; 95% CI,1.09-2.19; p=0.02) and minor bleeding(OR,1.46; 95% CI,1.07-1.99; p=0.02) in TT group. However, when restricting data to only AF patients, the incidence of major bleeding was comparable between two groups. The incidence of death, stroke, stent thrombosis and major bleeding was comparable between TT and double therapy.Conclusion:1. Compared with DAPT, TT appears to be more effective in preventing thromboembolic events but poses patients to a higher risk of bleeding risk.2. Double therapy with wafarin and clopidogrel might be a feasible alternative to TT.