scholarly journals Editorial to the “safety and efficacy of direct oral anticoagulants compared to vitamin K antagonist post percutaneous coronary artery interventions in patients with atrial fibrillation: A systematic revie and meta‐analysis”

2020 ◽  
Vol 36 (2) ◽  
pp. 280-281
Author(s):  
Yasuo Okumura ◽  
Koichi Nagashima
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Vitamin K ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Safety And Efficacy ◽  
Percutaneous Coronary

Direct oral anticoagulants vs. vitamin K antagonist after percutaneous coronary interventions in patients with atrial fibrillation

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Alberto Cordero ◽  
José L. Ferreiro ◽  
Vicente Bertomeu-González ◽  
Moisés Rodríguez-Mañero ◽  
Lorenzo Fácila ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Percutaneous Coronary Interventions ◽  
Coronary Interventions ◽  
Percutaneous Coronary

scholarly journals Safety and efficacy outcomes of double vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulant-based randomized clinical trials

2019 ◽  
Author(s):  
Giuseppe Gargiulo ◽  
Andreas Goette ◽  
Jan Tijssen ◽  
Lars Eckardt ◽  
Thorsten Lewalter ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Antithrombotic Therapy ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Vitamin K Antagonist ◽  
Safety And Efficacy ◽  
Percutaneous Coronary ◽  
Triple Antithrombotic Therapy

Abstract Aims To investigate the safety and efficacy of double vs. triple antithrombotic therapy (DAT vs. TAT) in patients with atrial fibrillation (AF) and acute coronary syndrome or who underwent percutaneous coronary intervention (PCI). Methods and results A systematic review and meta-analysis was performed using PubMed to search for non-vitamin K antagonist oral anticoagulant (NOAC)-based randomized clinical trials comparing DAT vs. TAT in AF patients undergoing PCI. Four trials encompassing 10 234 patients (DAT = 5496 vs. TAT = 4738) were included. The primary safety endpoint (ISTH major or clinically relevant non-major bleeding) was significantly lower with DAT compared with TAT [risk ratio (RR) 0.66, 95% confidence interval (CI) 0.56–0.78; P < 0.0001; I2 = 69%], which was consistent across all available bleeding definitions. This benefit was counterbalanced by a significant increase of stent thrombosis (RR 1.59, 95% CI 1.01–2.50; P = 0.04; I2 = 0%) and a trend towards higher risk of myocardial infarction with DAT. There were no significant differences in all-cause and cardiovascular death, stroke and major adverse cardiovascular events. The comparison of NOAC-based DAT vs. vitamin K antagonist (VKA)-TAT yielded consistent results and a significant reduction of intracranial haemorrhage (RR 0.33, 95% CI 0.17–0.65; P = 0.001; I2 = 0%). Conclusion Double antithrombotic therapy, particularly if consisting of a NOAC instead of VKA and a P2Y12 inhibitor, is associated with a reduction of bleeding, including major and intracranial haemorrhages. This benefit is however counterbalanced by a higher risk of cardiac—mainly stent-related—but not cerebrovascular ischaemic occurrences.

scholarly journals Non-Vitamin K Antagonist Oral Anticoagulants and Risk of Myocardial Infarction in Patients with Atrial Fibrillation with or without Percutaneous Coronary Interventions: A Meta-Analysis

2021 ◽  
Vol 11 (10) ◽  
pp. 1013
Author(s):  
Stefan Grajek ◽  
Marta Kałużna-Oleksy ◽  
Jolanta M. Siller-Matula ◽  
Maksymilian Grajek ◽  
Michał Michalak
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Vitamin K ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Percutaneous Coronary Interventions ◽  
Coronary Interventions ◽  
Percutaneous Coronary ◽  
Significant Difference

The study aimed to assess the risk of myocardial infarction (MI) and major adverse cardiac events during non-vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin therapy in patients with atrial fibrillation (AF), both treated and not treated with percutaneous coronary interventions (PCI). In a systematic search, we selected eight randomized clinical trials with a total of 81,943 patients. Dabigatran, compared to warfarin, significantly increased the risk of MI (relative risk [RR] 1.38, 95% CI 1.14–1.67), while the FXa inhibitors’ effect did not differ significantly from warfarin (RR 0.96, 95% CI 0.86–1.09). The RR comparison between analyzed subgroups (dabigatran vs. FXa inhibitors) showed a significant difference (Chi2 = 9.51, df = 1, p = 0.002). In a network meta-analysis, dabigatran 110 mg b.i.d. increased the risk of MI compared to warfarin, apixaban, edoxaban, and rivaroxaban. Also, dabigatran 150 mg b.i.d. increased the risk of MI compared to warfarin, apixaban, and rivaroxaban. Moreover, we tried to estimate the treatment ranking of the best therapy for MI prevention in patients with AF treated with PCI. Rivaroxaban had a 90% probability of being ranked the best therapy for MI prevention, whereas dabigatran 110 mg had an 8.2% probability. Dabigatran 150 mg was the most effective in stroke prevention (94% probability). Each NOAC is associated with a different risk of MI. Furthermore, we should consider FXa inhibitors as the first line NOACs in AF and coronary artery disease patients. PROSPERO ID CRD42020179808.

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