Abstract 297: Dual Antiplatelet Therapy versus Triple Therapy with Anticoagulant Following Percutaneous Coronary Intervention in High Risk Patients Requiring Long-Term Anticoagulation: A Meta-Analysis

Abstract

Background: Dual antiplatelet therapy with aspirin and clopidogrel is the cornerstone of treatment to prevent major adverse cardiovascular events (MACE) in patients following percutaneous coronary intervention (PCI). In high-risk patients requiring long-term anticoagulant, the current literatures have controversial results in preventing MACE and bleeding events with the use of triple therapy with aspirin, clopidogrel and warfarin compared to dual antiplatelet therapy following PCI. The purpose of this meta-analysis was to compare the safety and efficacy of triple therapy with dual therapy following PCI in high-risk patients requiring long term anticoagulation. Methods: A literature search identified 4 prospective and 4 retrospective studies with total of 2439 patients requiring long term anticoagulation undergoing PCI. End points measured were bleeding events, deaths, ischemic stroke, myocardial infarction, stent thrombosis and MACE. The odds ratios (OR) with 95% confidence intervals (CI) were computed and two sided alpha error <0.05 considered as a level of significance. Results: In contrast to dual antiplatelet therapy, patients on triple therapy with anticoagulant had significantly lower stent thrombosis (OR: 0.45, CI: 0.21-0.94, p=0.03) and ischemic stroke (OR: 0.30, CI: 0.16-0.56, p<0.001) (Fig 1 - Zone A is dual therapy group, zone B is triple therapy group). No significant difference was found between two groups in overall bleeding events (OR: 1.57, CI: 0.87-2.85, p=0.14), major bleeding events(OR:1.21, CI: 0.57-2.59, p=0.62), deaths (OR:0.89, CI: 0.5-1.58, p=0.69), myocardial infarction (OR:1.31, CI: 0.85-2.02, p=0.22) and MACE (OR:0.61, CI:0.20-1.82, p=0.37). Conclusions: Our meta-analysis suggests that the triple therapy with anticoagulant does not increase bleeding compared to dual antiplatelet therapy. Moreover, triple therapy decreases stent thrombosis and ischemic stroke following PCI in patients requiring long-term anticoagulants. Our study did not show any difference in mortality between two groups. Triple therapy may be a favorable strategy following PCI in high-risk patients requiring long-term anticoagulation. The randomized control clinical trials are needed for further evaluation of long-term outcomes.