Safi U. Khan, MD; Mohammed Osman, MD; Muhammad U. Khan, MD; Muhammad Shahzeb Khan, MD; Di Zhao, PhD; Mamas A. Mamas, MB BCh, DPhil; Nazir Savji, MD; Ahmad Al-Abdouh, MD; Rani K. Hasan, MD, MHS; Erin D. Michos, MD, MHS
Financial Support: Drs. Michos and Zhao are funded by the Blumenthal Scholars Fund in Preventive Cardiology at Johns Hopkins University.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3763.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement: Study protocol: Submitted to PROSPERO. Statistical code and data set: Available from Dr. Khan (e-mail, firstname.lastname@example.org).
Corresponding Author: Safi U. Khan, MD, Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505; e-mail, email@example.com.
Current Author Addresses: Drs. S.U. Khan and M.U. Khan: Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26508.
Dr. Osman: Department of Cardiovascular Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26508.
Dr. M.S. Khan: 903 South Ashland Avenue, Apartment 1206, Chicago, IL 60607.
Dr. Zhao: Welch Center, Suite 2600, 2024 East Monument Street, Baltimore, MD 21205.
Dr. Mamas: Keele Cardiovascular Research Group, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, United Kingdom.
Dr. Savji: Division of Cardiology, Sheikh Zayed Tower, Suite 7122, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287.
Dr. Al-Abdouh: Department of Medicine, Saint Agnes Hospital, 900 South Caton Avenue, Baltimore, MD 21229.
Dr. Hasan: Division of Cardiology, Sheikh Zayed Tower, Suite 7125A, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287.
Dr. Michos: Division of Cardiology, The Johns Hopkins Hospital, Blalock 524-B, 600 North Wolfe Street, Baltimore, MD 21287.
Author Contributions: Conception and design: S.U. Khan.
Analysis and interpretation of the data: S.U. Khan, M. Osman, D. Zhao, N. Savji, E.D. Michos.
Drafting of the article: S.U. Khan, M. Osman, M.S. Khan, N. Savji, A. Al-Abdouh.
Critical revision of the article for important intellectual content: S.U. Khan, M. Osman, M.U. Khan, M.S. Khan, M.A. Mamas, N. Savji, R.K. Hasan, E.D. Michos.
Final approval of the article: S.U. Khan, M. Osman, M.U. Khan, M.S. Khan, D. Zhao, M.A. Mamas, N. Savji, A. Al-Abdouh, R.K. Hasan, E.D. Michos.
Provision of study materials or patients: S.U. Khan, M.U. Khan.
Statistical expertise: S.U. Khan, M. Osman, D. Zhao.
Administrative, technical, or logistic support: M. Osman, E.D. Michos.
Collection and assembly of data: S.U. Khan, M.U. Khan, M.S. Khan.
The safety and effectiveness of dual therapy (direct oral anticoagulant [DOAC] plus P2Y12 inhibitor) versus triple therapy (vitamin K antagonist plus aspirin and P2Y12 inhibitor) in patients with nonvalvular atrial fibrillation (AF) after percutaneous coronary intervention (PCI) is unclear.
To examine the effects of dual versus triple therapy on bleeding and ischemic outcomes in adults with AF after PCI.
Searches of PubMed, EMBASE, and the Cochrane Library (inception to 31 December 2019) and ClinicalTrials.gov (7 January 2020) without language restrictions; journal Web sites; and reference lists.
Randomized controlled trials that compared the effects of dual versus triple therapy on bleeding, mortality, and ischemic events in adults with AF after PCI.
Two independent investigators abstracted data, assessed the quality of evidence, and rated the certainty of evidence.
Four trials encompassing 7953 patients were selected. At the median follow-up of 1 year, high-certainty evidence showed that dual therapy was associated with reduced risk for major bleeding compared with triple therapy (risk difference [RD], −0.013 [95% CI, −0.025 to −0.002]). Low-certainty evidence showed inconclusive effects of dual versus triple therapy on risks for all-cause mortality (RD, 0.004 [CI, −0.010 to 0.017]), cardiovascular mortality (RD, 0.001 [CI, −0.011 to 0.013]), myocardial infarction (RD, 0.003 [CI, −0.010 to 0.017]), stent thrombosis (RD, 0.003 [CI, −0.005 to 0.010]), and stroke (RD, −0.003 [CI, −0.010 to 0.005]). The upper bounds of the CIs for these effects were compatible with possible increased risks with dual therapy.
Heterogeneity of study designs, dosages of DOACs, and types of P2Y12 inhibitors.
In adults with AF after PCI, dual therapy reduces risk for bleeding compared with triple therapy, whereas its effects on risks for death and ischemic end points are still unclear.
Khan SU, Osman M, Khan MU, et al. Dual Versus Triple Therapy for Atrial Fibrillation After Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis. Ann Intern Med. 2020;:. [Epub ahead of print 17 March 2020]. doi: https://doi.org/10.7326/M19-3763
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Published: Ann Intern Med. 2020.
Cardiology, Coronary Heart Disease, Percutaneous Coronary Intervention, Rhythm Disorders and Devices.
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