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Omission of aspirin in patients taking oral anticoagulation after percutaneous coronary intervention

a systematic review and meta-analysis

Zhang, Jiana,b,c,d,e; Wang, Zhenga,b,c,d,e; Sang, Wentaoa,b,c,d,e; Wei, Maozenga,b,c,d,e; Xu, Fenga,b,c,d,e; Chen, Yuguoa,b,c,d,e

doi: 10.1097/MCA.0000000000000698
Antiplatelet Therapy in PCI
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Background There is no consensus on optimal antiplatelet and anticoagulation therapy after coronary stenting.

Methods We identified randomized controlled trials (RCTs) published in PubMed, Cochrane Library, and Embase using the following keywords: ‘antiplatelet’, ‘dual therapy’, ‘triple therapy’, ‘antithrombosis’, ‘indication for anticoagulation’, ‘percutaneous coronary intervention’, and ‘RCTs’. Primary safety end points were relative bleeding events, and secondary efficacy end points were major adverse cardiovascular events including stent thrombosis, death, myocardial infarction, and stroke.

Results We identified three RCTs including 5387 patients, of whom 2719 (50.5%) received dual therapy (DT) and 2668 (49.5%) received triple therapy. Relative to triple therapy, DT was associated with lower Thrombolysis in Myocardial Infarction major bleeding [risk ratio (RR): 0.58; 95% confidence interval (CI): 0.42–0.82], Thrombolysis in Myocardial Infarction minor bleeding (RR: 0.46; 95% CI: 0.34–0.62), and clinical bleeding events (RR: 0.61; 95% CI: 0.47–0.81). There was no significant difference for the secondary efficacy end point. In subgroup analyses, results were similar by sex, bleeding risk, and stent type; however, DT appeared suitable for patients aged less than 75 years but not more than or equal to 75 years, implying that there may be no ideal therapy for patients older than 75 years to balance the risk of ischemia and bleeding at the same time.

Conclusion Among patients with an indication for oral anticoagulation after percutaneous coronary intervention, DT appears to be the optimal strategy.

aDepartment of Emergency Medicine and Chest Pain Center, Qilu Hospital of Shandong University

bClinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine

cKey Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province

dThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences

eThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Shandong University, Jinan, People’s Republic of China

Correspondence to Feng Xu, MD, PhD, Qilu Hospital, Shandong University, No. 107, Wen Hua Xi Road, Jinan, Shandong 250012, People’s Republic of China Tel: +86 531 8216 9325; fax: +86 531 8692 7544; e-mail: xufengsdu@126.com

Received August 21, 2018

Received in revised form November 26, 2018

Accepted December 8, 2018

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