Meta-analysis Of The Combination Of Warfarin And Clopidogrel After Coronary Stenting In Patients With Indications For Chronic Oral Anticoagulation

Objective:The optimal antithrombotic strategy for patients with chronic oral anticoagulation undergoing coronary stenting is unknown. Our study conducted a meta-analysis of6previous trials comparing the safety and efficacy of dual antithrombotic regimen of warfarin and clopidogrel to triple antithrombotic regimen (including warfarin, aspirin and clopidogrel) in those patients.Methods:Two investigators independently searched Pubmed, Embase and Cochrane for all reported studies, and yielding6articles, published before April2015, enrolling4825patients, follow-up for at least12months. Two investigators independently recorded the data regarding interventions and the occurrence of major bleeding, ischemic stroke, myocardial infarction and death.Results: Patients with dual antithrombotic regimen had insignificant reduction in major bleeding (odds ratio [OR] is0.73,95%confidence interval [CI] is from0.46to1.14, and P=0.16) as compared with triple therapy. While the risk of ischemic stroke (OR= 0.78,95%CI:0.44-1.38, P=0.39), myocardial infarction (OR=1.19,95%CI:0.92-1.53, P=0.18) and the overall incidence of death (OR=0.95,95%CI:0.56-1.60, P=0.84) was also comparable between the two regimens.Conclusion:Dual antithrombotic regimen of warfarin and clopidogrel is comparable to the recommended triple therapy in respect to the prevention of thromboembolic outcomes of MI/death and ischemic stroke while the risk of bleeding was similar in those patients with indications for chronic oral anticoagulation undergoing percutaneous coronary intervention with stent implantation.