Meta-Analysis Comparing Oral Anticoagulant Monotherapy Versus Dual Antithrombotic Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2024-10-07 DOI:10.1002/clc.70026

Mushood Ahmed, Areeba Ahsan, Aimen Shafiq, Raheel Ahmed, Mahboob Alam, Pierre Sabouret, Jamal S. Rana, Gregg C. Fonarow

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Abstract

Background

Oral anticoagulants (OACs) are routinely used for the management of atrial fibrillation (AF) while antiplatelet agents are used in coronary artery disease (CAD). However, data regarding the comparative clinical outcomes of OAC monotherapy versus dual antithrombotic therapy (anticoagulant plus antiplatelet agent) in patients with AF and stable CAD are limited.

Methods

A comprehensive search of major databases including PubMed/MEDLINE, Cochrane Library, and Embase was performed from inception to September 1, 2024 to identify randomized control trials (RCTs) that compared OAC monotherapy with dual antithrombotic therapy in patients with AF and stable CAD. The risk ratios (RRs) were estimated with corresponding 95% confidence intervals (CIs) for all outcomes.

Results

A total of three RCTs reported data for 3945 patients with AF and stable CAD. The mean age of patients was 73.8 (±11.85) years and the mean follow-up was 22 months. OAC monotherapy was associated with a significantly reduced relative risk of major bleeding (RR: 0.55, 95% CI: 0.32–0.95) compared to dual therapy. The risk of all-cause death (RR: 0.85, 95% CI: 0.49–1.48), cardiovascular death (RR: 0.84, 95% CI: 0.50–1.41), any stroke event (RR: 0.74, 95% CI: 0.46–1.18), and myocardial infarction (RR: 1.57, 95% CI: 0.79–3.12) remained comparable across the two groups.

Conclusion

OAC monotherapy led to a significant relative risk reduction for major bleeding with similar rates of ischemic events and mortality compared to dual antithrombotic therapy in patients with AF and stable CAD.

Abstract Image

查看原文本刊更多论文

比较心房颤动和稳定型冠状动脉疾病患者口服抗凝剂单一疗法与双重抗血栓疗法的 Meta 分析。

背景：口服抗凝剂（OAC）是治疗心房颤动（AF）的常规药物，而抗血小板药物则用于冠状动脉疾病（CAD）。然而，有关心房颤动和稳定型冠状动脉疾病患者的口服抗心律失常药单一疗法与双重抗血栓疗法（抗凝剂加抗血小板药物）的临床疗效比较数据十分有限：方法：对主要数据库（包括 PubMed/MEDLINE、Cochrane Library 和 Embase）进行了全面检索，检索时间从开始到 2024 年 9 月 1 日，目的是确定在房颤和稳定型 CAD 患者中比较 OAC 单一疗法与双重抗血栓疗法的随机对照试验 (RCT)。对所有结果的风险比（RR）及相应的 95% 置信区间（CI）进行了估算：共有三项 RCT 报告了 3945 名房颤和稳定型 CAD 患者的数据。患者的平均年龄为 73.8 (±11.85) 岁，平均随访时间为 22 个月。与双重疗法相比，OAC 单一疗法显著降低了大出血的相对风险（RR：0.55，95% CI：0.32-0.95）。两组患者发生全因死亡（RR：0.85，95% CI：0.49-1.48）、心血管死亡（RR：0.84，95% CI：0.50-1.41）、任何卒中事件（RR：0.74，95% CI：0.46-1.18）和心肌梗死（RR：1.57，95% CI：0.79-3.12）的风险仍然相当：结论：与双联抗栓疗法相比，OAC单药疗法可显著降低房颤合并稳定型CAD患者大出血的相对风险，但缺血事件发生率和死亡率与双联抗栓疗法相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.