DOAC plus DAPT cuts risk of bleeding in AF patients with coronary disease
Direct oral anticoagulants (DOACs) in combination with dual antiplatelet therapy (DAPT), compared with vitamin K antagonists (VKAs), correlate with a reduced risk of bleeding and similar thromboembolic protection in atrial fibrillation (AF) patients with myocardial infarction (MI) and/or after percutaneous coronary intervention (PCI), a recent study has shown.
Of the 3,222 patients included in the study, 875 (27 percent) were treated with VKA+single antiplatelet therapy (SAPT), 595 (18 percent) with DOAC+SAPT, 1,074 (33 percent) with VKA+DAPT and 678 (22 percent) with DOAC+DAPT.
A significant difference was observed at 3 months in the absolute risk of MI associated with DOAC+SAPT vs VKA+SAPT (3-month absolute risk difference [ARD], –1.53; 95 percent CI, –3.08 percent to –0.11 percent). There were no significant differences regarding bleeding, ischaemic stroke and all-cause mortality.
DOAC+DAPT correlated with a significantly reduced risk of bleeding (3-month ARD, –1.96; –3.46 percent to –0.88 percent) compared with VKA+DAPT, with no significant difference in the absolute risk of all-cause mortality, stroke or MI.
In this study, the investigators used Danish nationwide registries to identify AF patients who were admitted with a MI and/or underwent PCI, between August 2011 and June 2017, treated with oral anticoagulant in combination with antiplatelets (ie, aspirin, clopidogrel or both). They followed patients for 12 months or until an outcome, study end or death.
Based on outcome-specific Cox regression models adjusted for potential confounders, the investigators estimated standardized absolute risks. They used the g-formula to obtain average treatment effects as standardized ARD in risks at 3 and 12 months.