Vol. 53 | No. 1 | January-June 2025Back

Open Access

Dual Therapy Versus Triple Therapy Major Bleeding Outcomes in Patients With Atrial Fibrillation Who Developed Indications for Percutaneous Coronary Intervention: A Meta-Analysis

Mary Martinae Lim Miro, Jonald Lucero
May 2025 DOI 10.69944/pjc.1c6494e655

More Info

Mary Martinae Lim Miro, CPh, MD  Jonald Lucero, MD
Perpetual Succour Hospital, Cebu City, Cebu 6000 Philippines


Correspondence:
Dr. Mary Martinae Lim Miro
Perpetual Succour Hospital, Cebu City, Cebu 6000 Philippines
Email: marymartinaemiro@yahoo.com


DISCLOSURE: None

References
  1. Knijnik L, Rivera M, Blumer V, Cardoso R, Fernandes A, Fernandes G, et al. Prevention of stroke in atrial fibrillation after coronary stenting: Systematic review and network meta-analysis. Stroke [Internet]. 2019;50(8):2125–32. Available from: http://dx.doi.org/10.1161/STROKEAHA.119.026078  
  2. Szapáry L, Tornyos D, Kupó P, Lukács R, El Alaoui El Abdallaoui O, Komócsi A. Combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials. Front Cardiovasc Med [Internet]. 2022;9:1036609. Available from: http://dx.doi.org/10.3389/fcvm.2022.1036609  
  3. Boyd RL, Tasseff N, Xu B. Contemporary review on the management of oral anticoagulation and anti-platelet therapies in patients undergoing percutaneous coronary intervention with concurrent atrial fibrillation. AME Med J [Internet]. 2021;6:31–31. Available from: http://dx.doi.org/10.21037/amj-21-9  
  4. Koiwaya H, Watanabe N, Kuriyama N, Shibata Y. Direct oral anticoagulants would be best choice for atrial fibrillation patients after coronary stenting: Retrospective study in a Japanese population. Kurume Med J [Internet]. 2023;68(2):97–106. Available from: https://www.jstage.jst.go.jp/article/kurumemedj/advpub/0/advpub_MS682015/_pdf  
  5. Yashima F, Inohara T, Nishida H, Shimoji K, Ueno K, Noma S, et al. In-hospital bleeding outcomes of oral anticoagulant and dual antiplatelet therapy during percutaneous coronary intervention: An analysis from the Japanese nationwide registry. J Cardiovasc Pharmacol [Internet]. 2021;78(2):221–7. Available from: http://dx.doi.org/10.1097/FJC.0000000000001006  
  6. Vranckx P, Lewalter T, Valgimigli M, Tijssen JG, Reimitz P-E, Eckardt L, et al. Evaluation of the safety and efficacy of an edoxaban-based antithrombotic regimen in patients with atrial fibrillation following successful percutaneous coronary intervention (PCI) with stent placement: Rationale and design of the ENTRUST-AF PCI trial. Am Heart J [Internet]. 2018;196:105–12. Available from: http://dx.doi.org/10.1016/j.ahj.2017.10.009
  7. Choxi R, Kapoor K, Mackman N, Jovin IS. Direct oral anticoagulants and coronary artery disease. Arterioscler Thromb Vasc Biol [Internet]. 2022;42(5):553–64. Available from: http://dx.doi.org/10.1161/ATVBAHA.121.317171  
  8. Xu K, Chan NC. Bleeding in patients with atrial fibrillation treated with combined antiplatelet and anticoagulant therapy: time to turn the corner. Ann Transl Med [Internet]. 2019;7(Suppl 6):S198. Available from: http://dx.doi.org/10.21037/atm.2019.07.40  
  9. Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, et al. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med [Internet]. 2019;380(16):1509–24. Available from: http://dx.doi.org/10.1056/NEJMoa1817083  
  10. Cannon CP, Bhatt DL, Oldgren J, Lip GYH, Ellis SG, Kimura T, et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med [Internet]. 2017;377(16):1513–24. Available from: http://dx.doi.org/10.1056/NEJMoa1708454  
  11. Gibson CM, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P, et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med [Internet]. 2016;375(25):2423–34. Available from: http://dx.doi.org/10.1056/NEJMoa1611594  
  12. Vranckx P, Lewalter T, Valgimigli M, Tijssen JG, Reimitz P-E, Eckardt L, et al. Evaluation of the safety and efficacy of an edoxaban-based antithrombotic regimen in patients with atrial fibrillation following successful percutaneous coronary intervention (PCI) with stent placement: Rationale and design of the ENTRUST-AF PCI trial. Am Heart J [Internet]. 2018;196:105–12. Available from: http://dx.doi.org/10.1016/j.ahj.2017.10.009  
  13. Chang Y, Phillips MR, Guymer RH, Thabane L, Bhandari M, Chaudhary V, et al. The 5 min meta-analysis: understanding how to read and interpret a forest plot. EYE [Internet]. 2022;36(4):673–5. Available from: http://dx.doi.org/10.1038/s41433-021-01867-6  
Tables and Figures

Supplemental Figure 1

 

A diagram of a graph Description automatically generated

Supplemental Figure 1. Funnel Plot for Assessment of DOAC + P2Y12 Versus VKA + DAPT on ISTH Major Bleeding or Clinically Significant Non-Major Bleeding

 

Supplemental Figure 2

 

A diagram of a triangle Description automatically generated

Supplemental Figure 2. Funnel Plot for Assessment of DOAC + P2Y12 Versus VKA + DAPT on Stent Thrombosis

Supplemental Figure 3

 

A diagram of a triangle with red and blue dots Description automatically generated

Supplemental Figure 3. Funnel Plot for Assessment of DOAC + P2Y12 Versus VKA + DAPT on Major Adverse Cardiovascular Events

 

Supplemental Figure 4

 

A line graph with dots and numbers Description automatically generated

Supplemental Figure 4. Funnel Plot for Assessment of Reduced Dose Versus Standard Dose DOACs on Major Adverse Cardiovascular Events

 

 

Supplemental Figure 5

 

A graph of a triangle Description automatically generated

Supplemental Figure 5. Funnel Plot for Assessment of Reduced Dose Versus Standard Dose DOACs on Stent Thrombosis

 

License

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.