Abstract
ObjectiveThe aim of this systematic review and network meta-analysis was to evaluate the comparative efficacy and safety of antiplatelet agents, vitamin K antagonist (VKA) and non-VKA oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).MethodsPubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify clinical trials comparing antiplatelet drugs with VKA and NOACs or their combination in AF patients undergoing PCI with a mean/median follow-up of at least 12 months. A network meta-analysis was conducted to directly and indirectly compare the efficacy and safety of competitive antithrombotic regimens with a Bayesian random-effects model. Results were presented as relative risks (RRs) and 95% confidence intervals (CIs).ResultsA total of 15 studies enrolling 13,104 patients were included. Among 5 regimens, rivaroxaban 15 mg daily plus P2Y12 inhibitor treatment demonstrated significant superiority over dual- and triple-antiplatelet therapies (DAPT, TT) in reducing thromboembolic events (0.64 [0.38, 0.95] and 0.68 [0.43, 0.98], respectively) but showed the maximum possibility of major bleeding risk, while VKA plus single antiplatelet therapy (SAPT) seemed the safest. Significantly less risk of major bleeding was seen in DAPT group than that in TT group (0.63 [0.39, 0.99]).ConclusionsThe present study suggests that combination of VKA and SAPT is the best choice for AF patients undergoing PCI considering both efficacy and safety. Rivaroxaban 2.5 mg twice daily plus DAPT treatment owns the highest probability to be the optimal alternative to VKA plus SAPT for these patients.
Highlights
Percutaneous coronary intervention (PCI) with dual-antiplatelet therapy (DAPT, aspirin and P2Y12 inhibitor or thienopyridine) is a standardized treatment for coronary artery disease (CAD) patients with moderate or severe coronary artery stenosis, 5% to 15% of whom are concomitant atrial fibrillation (AF)[1,2,3]
The present study suggests that combination of vitamin K antagonist (VKA) and single antiplatelet therapy (SAPT) is the best choice for AF patients undergoing PCI considering both efficacy and safety
Loading doses of aspirin and ticagrelor or clopidogrel were administered to acute coronary syndrome (ACS) patients and before PCI according to guideline[27]
Summary
Percutaneous coronary intervention (PCI) with dual-antiplatelet therapy (DAPT, aspirin and P2Y12 inhibitor or thienopyridine) is a standardized treatment for coronary artery disease (CAD) patients with moderate or severe coronary artery stenosis, 5% to 15% of whom are concomitant atrial fibrillation (AF)[1,2,3]. The clinical evidence has been deficient to support the strategy decision and prescribe individualized antithrombotic regimens for AF patients undergoing PCI. Antithrombotic efficacy and bleeding risk of NOACs for AF patients undergoing PCI in the real world has not been well established yet, several clinical studies have yielded different results of several antiplatelet and anticoagulant regimens for these patients[6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]. This systematic review and network meta-analysis (NMA) aimed to rank efficacy and safety of different antithrombotic therapies available for AF patients in post-PCI
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