Dual Therapy Versus Triple Therapy After PCI in Patients with Atrial Fibrillation

A metanalysis confirms that a direct oral anticoagulant plus a P2Y₁₂ inhibitor reduces bleeding, but evidence for equivalence with triple therapy for ischemic endpoints remains inconclusive.

What to prescribe for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remains a common clinical conundrum. In this meta-analysis, investigators pooled data on 7953 patients from four randomized clinical trials comparing dual therapy with a direct oral anticoagulant (DOAC) plus a P2Y₁₂ inhibitor to triple therapy with a vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT; P2Y₁₂ inhibitor and aspirin).

Median study follow-up was 1 year. Dual therapy was associated with lower rates for major and minor bleeding (risk reductions, –1.3% and –3.1%, respectively) with a high certainty of evidence. Although dual- and triple-therapy approaches did not significantly differ in the risks for death, c…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)