| Objective:Data regarding the clinical outcomes in patients with atrial fibrillation(AF)receiving dual antiplatelet therapy(DAPT)and an anticoagulant in addition to DAPT(DAPT+VKA)after coronary stent implantation are still controversial.Therefore,in order to solve this issue,we aim to compare the adverse clinical outcomes in AF patients receiving DAPT and DAPT +VKA after percutaneous coronary intervention and stenting(PCI-S).Methods:Observational studies comparing the adverse clinical outcomes such as major bleeding,major adverse cardiovascular events(MACEs),stroke,myocardial infarction,all-cause mortality and stent thrombosis in atrial fibrillation(AF)patients receiving DAPT+VKA therapy and DAPT after PCI-S have been searched from Medline,EMBASE,and PubMed databases.Odds ratios(OR)with 95%confidence intervals(CI)were used to express the pooled effect on discontinuous variables,and the pooled analyses were performed with RevMan 5.3.Results:Eighteen studies consisting of a total of 20,456 patients with AF(7,203 patients received DAPT+VKA and 13,253 patients received DAPT after PCI-S)were included in this meta-analysis.At a mean follow-up period of 15 months,the risk of major bleeding was significantly higher in DAPT+VKA group with OR:0.62,95%CI:0.50-0.77,P<0.0001.There was no significant differences in MI and MACE between DAPT+VKA and DAPT with OR:1.27,95%CI:0.92-1.77,P=0.15,and OR:1.17,95%CI:0.99-1.39,P=0.07,respectively.However,the stent thrombosis(ST),stroke and all-cause mortality were significantly lower in DAPT+VKA group with OR:1.98,95%CI:1.03-3.81,P=0.04,OR:1.59,95%CI:1.08-2.34,P=0.02,and OR:1.41,95%CI:1.03-1.94,P=0.03,respectively.Conclusion:At a mean follow-up period of 15 months,DAPT+VKA was associated with significantly lower risk of stroke,stent thrombosis,and all-cause mortality in AF patients after PCI-S compared to DAPT group.However,the risk of major bleeding was significantly higher in the DAPT+VKA group. |
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