Dual better than triple antithrombotic therapy after percutaneous coronary intervention
Compared to triple therapy, dual antithrombotic therapy yields reduced bleeding without excess ischaemic and thromboembolic cardiac events in patients with long-term indication to chronic oral anticoagulation (OAC) following percutaneous coronary intervention (PCI), according to a new study.
The researchers performed a meta-analysis of four randomized controlled trials (n=6,036) receiving chronic OAC after PCI. Incidences of major and minor bleeding, myocardial infarction, stroke and all-cause death, among other outcomes, were compared between those receiving dual and triple therapy.
Over the mean follow-up duration of 11.7 months, the incidence of major bleeding was 1.97 percent in patients receiving dual therapy, lower than the 3.53 percent in those on triple therapy. This finding yielded a significant 45-percent decrease in relative risk (p=0.0007).
A similar trend was observed with minor bleeding, where the relative risk was 43 percent lower with the dual vs triple therapy (3.30 percent vs 7.18 percent; p=0.00001).
Incidence of the other endpoints, such as all-cause mortality (3.81 percent vs 4.01 percent; p=0.37) and cardiovascular mortality (1.62 percent vs 2.02 percent; p=0.42) were statistically comparable between the dual and triple therapies.
“In conclusion, this large study level meta-analysis on patients candidates to OAC, mainly for AF, and undergoing PCI indicates that dual antithrombotic therapy significantly reduces major and minor bleeding compared to triple therapy,” said researchers, noting that the findings translated to 15 major and 39 minor bleeding events per 1,000 patients at 1 year, were prevented by dual therapy.
“Interestingly, the use of dual therapy led to a numerically lower mortality, although not statistically significant, probably due to the low number of events,” they added, emphasizing that limitations, such as lack of access to individual information and scarcity of available studies, warrant further, larger investigations.