Meta-Analysis of Oral Anticoagulants with Dual versus Single Antiplatelet Therapy in Patients after Percutaneous Coronary Intervention.

BACKGROUND: The combined use of dual antiplatelet therapy with oral anticoagulation (OAC) is required after coronary artery stenting or acute coronary syndromes (ACS).

METHODS AND RESULTS: We performed a meta-analysis (Embase and MEDLINE search) of the comparative effects of triple antithrombotic therapy (TT) versus OAC with single antiplatelet therapy (dual therapy [DT]) on all-cause mortality, stroke, cardiovascular death, myocardial infarction (MI), target vessel revascularization, and major bleeding. Three prospective controlled studies and five cohort studies compared TT versus DT. We identified three prospective controlled and five cohort studies with 4564 patients on TT and 1848 on DT with an average follow-up duration of 10.1 months. TT is associated with similar rates of all-cause mortality, stroke, and major bleeding but significantly lower rates of MI compared with DT.

CONCLUSIONS: Triple antithrombotic therapy is associated with similar mortality and bleeding rates but fewer MIs compared with OAC and single antiplatelet therapy.