Therapeutic effect of antithrombotic drug combinations in patients with atrial fibrillation undergoing percutaneous coronary intervention for coronary heart disease: a meta-analysis

Objective: To explore suitable treatment strategies for patients with coronary heart disease and atrial fibrillation after percutaneous coronary intervention (PCI) via systematically analyzing and comparing the clinical ef-ficacy of dual antithrombotic therapy (DAT) and triple antithrombotic therapy (TAT). Methods: Pubmed, Embase and Cochrane Library databases were searched. The literature from the database establishment to August 2022 was re-viewed by 2 researchers separately according to the inclusion and exclusion criteria and the method recommended by the Cochrane Collaboration. The data was extracted for quality assessment. The primary endpoints of the study were safety endpoints and efficacy endpoints, the former includes major bleeding events and the latter includes mortality, myocardial infarction, stent thrombosis and stroke. RevMan5.4 software was used for meta-analysis. Results: There were 11 studies were included for the meta-analysis, 5 observational studies and 6 randomized con-trolled trials. The number of patients included was 2,4032, of which 13818 (57.5%) received DAT and 9483 (39.5%) received TAT. Our analyses indicated that compared with TAT treatment, DAT significantly reduced the incidence of major bleeding (OR=0.71, 95% CI [0.61, 0.83], P < 0.0001) and the incidence of minor bleeding (OR=0.61, 95% CI [0.50, 0.75], P < 0.00001). Subgroup analysis showed that DAT with novel oral anticoagulants (NOACs) reduced major bleeding (OR=0.64, 95% CI [0.54, 0.76], P < 0.00001) and the incidence of minor bleeding (OR=0.56, 95% CI [0.45, 0.69], P < 0.00001), but DAT with vitamin K antagonists (VKAs) was not significantly different from TAT in ma-jor bleeding (OR=1.20, 95% CI [0.82, 1.75], P=0.35) and minor bleeding (OR=1.15, 95% CI [0.64, 2.05], P=0.64). Conclusions: DAT with NOACs has a higher safety profile against bleeding in patients with atrial fibrillation after PCI. DAT with VKAs was similar to TAT in terms of antithrombotic effect and incidence of bleeding.