Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysis

Objective Creating an appropriate antithrombotic therapy for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) remains a dilemma. Several clinical trials compared the use of a dual antithrombotic therapy (DAT) regimen with a direct oral anticoagulants...

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Main Authors: Abdulaali R Almutairi, Renad M Altoukhi, Reema A Alshouimi, Shahad M Al Rammah, Mohammed Y Alzahrani, Abdulmajeed M Alshehri, Osamah M Alfayez, Majed S Al Yami, Omar A Almohammed
Format: Article
Language:English
Published: BMJ Publishing Group 2020-09-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/10/9/e036138.full
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author Abdulaali R Almutairi
Renad M Altoukhi
Reema A Alshouimi
Shahad M Al Rammah
Mohammed Y Alzahrani
Abdulmajeed M Alshehri
Osamah M Alfayez
Majed S Al Yami
Omar A Almohammed
author_facet Abdulaali R Almutairi
Renad M Altoukhi
Reema A Alshouimi
Shahad M Al Rammah
Mohammed Y Alzahrani
Abdulmajeed M Alshehri
Osamah M Alfayez
Majed S Al Yami
Omar A Almohammed
author_sort Abdulaali R Almutairi
collection DOAJ
description Objective Creating an appropriate antithrombotic therapy for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) remains a dilemma. Several clinical trials compared the use of a dual antithrombotic therapy (DAT) regimen with a direct oral anticoagulants including (apixaban, dabigatran, edoxaban or rivaroxaban) and a P2Y12 inhibitor versus a triple antithrombotic therapy (TAT) that includes a vitamin K antagonist plus aspirin and a P2Y12 inhibitor in patients with AF who have undergone PCI. However, there are no head-to-head trials comparing the DAT regimens to each other. We aimed to compare the efficacy and safety of DAT regimens using a network meta-analysis (NMA) approach.Design A systematic review and NMA of randomised clinical trials.Methods We conducted a systematic literature review to identify relevant randomised clinical trials and performed a Bayesian NMA for International Society on Thrombosis and Haemostasis (ISTH) major or clinically relevant non-major (CRNM) bleeding, all-cause mortality, stroke, myocardial infarction (MI) and stent thrombosis outcomes. We used NetMetaXL V.1.6.1 and WinBUGS V.1.4.3 for the NMA and estimated the probability of ranking the treatments based on the surface under the cumulative ranking curve.Results The comparison between DAT regimens showed no significant difference in the safety or efficacy outcomes. Apixaban regimen was ranked first as the preferred therapy in terms of ISTH major or CRNM bleeding and stroke, with a probability of 52% and 54%, respectively. Rivaroxaban regimen was the preferred therapy in terms of MI and stent thrombosis, with a probability of 34% and 27%, respectively. Dabigatran regimen was ranked first in terms of all-cause mortality, with a probability of 28%.Conclusion The DAT regimens are as safe and effective as TAT regimens. However, ranking probabilities for the best option in the selected outcomes can be used to guide the selection among these agents based on different patients’ conditions.
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spelling doaj-art-da73c2b8fff64a0bac290bfe79f9484c2025-01-06T14:15:13ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2019-036138Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysisAbdulaali R Almutairi0Renad M Altoukhi1Reema A Alshouimi2Shahad M Al Rammah3Mohammed Y Alzahrani4Abdulmajeed M Alshehri5Osamah M Alfayez6Majed S Al Yami7Omar A Almohammed8Saudi Food and Drug Authority, Drug Sector, Riyadh, Saudi ArabiaCollege of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCollege of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCollege of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCollege of Pharmacy–Department of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCollege of Pharmacy–Department of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCollege of Pharmacy–Department of Pharmacy Practice, Qassim University, Buraidah, Saudi ArabiaCollege of Pharmacy–Department of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCollege of Pharmacy–Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi ArabiaObjective Creating an appropriate antithrombotic therapy for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) remains a dilemma. Several clinical trials compared the use of a dual antithrombotic therapy (DAT) regimen with a direct oral anticoagulants including (apixaban, dabigatran, edoxaban or rivaroxaban) and a P2Y12 inhibitor versus a triple antithrombotic therapy (TAT) that includes a vitamin K antagonist plus aspirin and a P2Y12 inhibitor in patients with AF who have undergone PCI. However, there are no head-to-head trials comparing the DAT regimens to each other. We aimed to compare the efficacy and safety of DAT regimens using a network meta-analysis (NMA) approach.Design A systematic review and NMA of randomised clinical trials.Methods We conducted a systematic literature review to identify relevant randomised clinical trials and performed a Bayesian NMA for International Society on Thrombosis and Haemostasis (ISTH) major or clinically relevant non-major (CRNM) bleeding, all-cause mortality, stroke, myocardial infarction (MI) and stent thrombosis outcomes. We used NetMetaXL V.1.6.1 and WinBUGS V.1.4.3 for the NMA and estimated the probability of ranking the treatments based on the surface under the cumulative ranking curve.Results The comparison between DAT regimens showed no significant difference in the safety or efficacy outcomes. Apixaban regimen was ranked first as the preferred therapy in terms of ISTH major or CRNM bleeding and stroke, with a probability of 52% and 54%, respectively. Rivaroxaban regimen was the preferred therapy in terms of MI and stent thrombosis, with a probability of 34% and 27%, respectively. Dabigatran regimen was ranked first in terms of all-cause mortality, with a probability of 28%.Conclusion The DAT regimens are as safe and effective as TAT regimens. However, ranking probabilities for the best option in the selected outcomes can be used to guide the selection among these agents based on different patients’ conditions.https://bmjopen.bmj.com/content/10/9/e036138.full
spellingShingle Abdulaali R Almutairi
Renad M Altoukhi
Reema A Alshouimi
Shahad M Al Rammah
Mohammed Y Alzahrani
Abdulmajeed M Alshehri
Osamah M Alfayez
Majed S Al Yami
Omar A Almohammed
Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysis
BMJ Open
title Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysis
title_full Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysis
title_fullStr Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysis
title_full_unstemmed Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysis
title_short Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysis
title_sort safety and efficacy of dual versus triple antithrombotic therapy dat vs tat in patients with atrial fibrillation following a pci a systematic review and network meta analysis
url https://bmjopen.bmj.com/content/10/9/e036138.full
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