Dual vs. Triple Antithrombotic Therapy Meta-Analysis

Study Questions:

What is the safety and efficacy of dual versus triple antithrombotic therapy (DAT vs. TAT) in patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI)?


The authors performed a systematic review and meta-analysis of Phase 3 randomized trials comparing DAT versus TAT. Four trials including 5,317 patients were included.


Compared with the TAT arm, major or minor bleeding was reduced in the DAT arm (4.3% vs. 9.0%, hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.36-0.85). There was no difference in the risk of major adverse cardiac events (10.4% vs. 10.0%, HR, 0.85; 95% CI, 0.48-1.29) or of the individual components (all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, or stroke).


The authors concluded that compared with TAT, DAT reduced the risk of bleeding without any difference in the risk of major adverse cardiac events.


Coronary artery disease is one of the most common comorbidities for patients with AF. Balancing the need for stroke and coronary thromboembolic prevention with the risk of bleeding has been a topic of increasing discussion and debate over the past decade. This meta-analysis concludes that use of TAT increases bleeding risk without an additional reduction in major adverse cardiac event risk as compared to DAT. Of course, this finding only applies to the patients with AF and PCI who were eligible for randomization in the trials. Nonetheless, clinicians should probably be starting with a plan for DAT and trying to identify if there are additional risk factors that necessitate TAT (preferably short-term) in their patients with comorbid AF and PCI.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and Coronary Artery Disease

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Coronary Artery Disease, Fibrinolytic Agents, Hemorrhage, Myocardial Infarction, Percutaneous Coronary Intervention, Risk Factors, Secondary Prevention, Stents, Stroke, Thrombosis, Vascular Diseases

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