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Eur Heart J. 2018 May 14;39(19):1726-1735a. doi: 10.1093/eurheartj/ehy162.

Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of randomized clinical trials.

Author information

Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA.
Baim Institute for Clinical Research, 930 Commonwealth Ave#3, Boston, MA 02215, USA.
FACT, French Alliance for Cardiovascular Trials; Hôpital Bichat, AP-HP; Université Paris-Diderot; and INSERM U-1148, Paris, France.
Department of Biostatistics, School of Public Health, Boston University, 801 Massachusetts Ave Crosstown Center, Boston, MA 02218, USA.
Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Akademiska sjukhuset, Ing.40, 5 tr, Uppsala 75185, Sweden.
Department of Cardiology, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3435 CM Nieuwegein, Netherlands.
Department of Cardiovascular Medicine, Kyoto University Hospital, 54 Shogoin Kawaharacho, Sakyo Ward, Kyoto, Kyoto Prefecture 606-8507, Japan.
Department of Cardiology, Division of Cardiac Electrophysiology, Johann Wolfgang Goethe University, Building 23 C, Theodor Stern Kai 7, 60590 Frankfurt, Germany.
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B 12 7QH, UK.



Of patients with atrial fibrillation (AF), approximately 10% undergo percutaneous coronary intervention (PCI). We studied the safety and efficacy of dual vs. triple antithrombotic therapy (DAT vs. TAT) in this population.

Methods and results:

A systematic review and meta-analysis was conducted using PubMed, Embase, EBSCO, Cochrane database of systematic reviews, Web of Science, and relevant meeting abstracts for Phase 3, randomized trials that compared DAT vs. TAT in patients with AF following PCI. Four trials including 5317 patients were included, of whom 3039 (57%) received DAT. Compared with the TAT arm, Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding showed a reduction by 47% in the DAT arm [4.3% vs. 9.0%; hazard ratio (HR) 0.53, 95% credible interval (CrI) 0.36-0.85, I2 = 42.9%]. In addition, there was no difference in the trial-defined major adverse cardiac events (MACE) (10.4% vs. 10.0%, HR 0.85, 95% CrI 0.48-1.29, I2 = 58.4%), or in individual outcomes of all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, or stroke between the two arms.


Compared with TAT, DAT shows a reduction in TIMI major or minor bleeding by 47% with comparable outcomes of MACE. Our findings support the concept that DAT may be a better option than TAT in many patients with AF following PCI.

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