Abstract
Funding Acknowledgements
Type of funding sources: None.
Background- The efficacy and safety of oral Anticoagulation (OAC)with either Warfarin or Direct oral anticoagulants (DOACs) as compared with combination therapy of oral anticoagulant and antiplatelet (OAC + APT) in patients with atrial fibrillation and stable coronary artery disease more than 1 year after stenting is not known.
Methods-Electronic databases ( PubMed, Embase, Scopus) were searched from inception to December 28th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05. The primary efficacy end point was MACCE definied as composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause The primary safety end point was major bleeding, according to the criteria of the International Society on Thrombosis and Hemostasis; this end point was analyzed for superiority.
Results- A total of seven studies with 81,303(OAC = 56,633; OAC + APT = 24670) participants were included. There was no statistically significant differences in MACCE among patients treated using OAC monotherapy compared with those treated with OAC + APT (HR 1.09; 95% CI 0.93-1.29; p = 0.28). OAC + APT was associated with a significantly higher risk of major bleeding compared with OAC monotherapy (HR 1.65; 95% CI 1.30-2.11; p < 0.0001)
Conclusion- Amongst patients with atrial fibrillation and concomitant stable coronary artery disease, OAC monotherapy is non-inferior to combination therapy with OAC and single antiplatelet agent. OAC monotherapy reduced the risk for major or life-threatening bleeding events, while not increasing the risk for major adverse cardiovascular events.
Abstract Figure.
Antiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients Taking an Oral Anticoagulant
