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Short-term versus long-term triple antithrombotic therapy for patients with coronary stents and requiring oral anticoagulation

a meta-analysis of randomized clinical trials

Shah, Rahmana; Khan, Sajjad A.b; Khan, Babara; Latham, Samuel B.a

doi: 10.1097/MCA.0000000000000690
Antiplatelet Therapy in PCI
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Background The cornerstone therapy for patients with coronary stents is dual antiplatelet therapy (DAPT). In 5–10% of these patients, oral anticoagulation (OAC) is clearly indicated in addition to DAPT. However, the optimal duration of this triple antithrombotic therapy (TAT) remains uncertain.

Patients and methods Scientific databases and websites were searched for randomized clinical trials (RCTs). RCTs were included if patients undergoing coronary stent placements with additional indications of chronic OAC were randomly assigned to either short-term TAT or long-term TAT. Short-term TAT was defined as no more than 6 weeks of TAT, and long-term TAT was defined as 6–12 months of TAT

Results Using data from three RCTs and 1883 patients, short-term TAT was associated with decreased rates of major adverse cardiovascular events, cardiac mortality, all-cause mortality, and any-bleeding events compared to long-term TAT, but similar rates of myocardial infarction, stroke, stent thrombosis, and thrombolysis in myocardial infarction major bleeding. Furthermore, in subgroup analysis, short-term TAT was associated with decreased rates of major adverse cardiovascular events, cardiac mortality, all-cause mortality, and any-bleeding compared to 12-month TAT, but similar rates compared to 6-month TAT.

Conclusion In patients who require chronic OAC therapy and undergo coronary stent placement, short-term TAT was associated with better efficacy and safety outcomes compared to long-term TAT.

aDepartment of Medicine, School of Medicine, University of Tennessee, Memphis Tennessee, USA

bDepartment of Medicine, Aga Khan University, Karachi, Pakistan

Correspondence to Rahman Shah, MD, Section of Cardiovascular Medicine, Department of Medicine, School of Medicine, University of Tennessee, 1030 Jefferson Avenue, Memphis, TN 38104, USA Tel: +1 901 523 8990 x6567; fax: +1 901 577 7323; e-mail: shahcardiology@yahoo.com

Received October 4, 2018

Accepted November 24, 2018

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