Abstract 15942: Oral Anticoagulation as Compared to Oral Anticoagulation Plus Single Antiplatelet Therapy in Stable Coronary Artery Disease With Af: A Meta-analysis
Introduction: There are limited data on the appropriate antithrombotic therapy in patients with stable coronary artery disease (CAD) and concurrent atrial fibrillation (AF). The efficacy of using a single antiplatelet (SAP) in addition to oral anticoagulation (OAC) as compared to OAC alone remains controversial, with the earlier regimen associated with increased risk of major bleeding. Methods: A systematic electronic search of the PubMed, EMBASE and Cochrane databases was performed to identify relevant publications. Inclusion criteria were randomized controlled studies (RCTs) and observational studies comparing OAC+SAPT to OAC alone in patients with stable CAD and concurrent AF. All-cause mortality, stroke and myocardial infarction (MI) were the endpoints analyzed. We used the inverse variance method with random-effect model to calculate the hazard ratio (HR) with 95% confidence interval (CI). Statistical heterogeneity was calculated using Higgins I2 statistics. All statistical analysis was performed using RevMan Version 5.3. Results: The final analysis included two RCTs and 3 observational studies comparing OAC+SAPT versus OAC alone in patients with stable CAD and AF. There was no difference in the rate of mortality between the two treatment strategies [HR: 1.13, 95%CI: 0.88-1.46, I2= 71%] [Figure, PANEL A]. Subgroup analysis based on RCTs and observation studies reported similar results. Additionally, there was no difference in the rate of stroke [HR: 1.24, 95%CI: 0.83-1.85, I2= 0%] [Figure, PANEL B]or MI [HR: 0.57, 95%CI: 0.29-1.14, I2= 0%] [Figure, PANEL C] between the two treatment strategies Conclusion: OAC+SAPT as compared to OAC alone in patients with stable CAD and AF was associated with similar rates of all-cause mortality, stroke and MI.