Meta-analysis Of Trials Comparing The Safety Of Dual Antiplatelet Therapy Versus Triple Antithrombotic Therapy In Patients With Atrial Fibrillation After PCI

Objective To compare the clinical outcomes of dual antiplatelet therapy(aspirin plus clopidogrel)and triple antithrombotic therapy(aspirin,clopidogrel combined with warfarin)in patients with atrial fibrillation after percutaneous coronary intervention.Method Based on the inclusion and exclusion criteria,we searched the Pubmed?EMBASE?Cochrane Library databases for all relevant literature from inception to 31 th December,2016.Then we used the Newcastle-Ottawa scale to evaluate the quality of these studies.Finally we analyzed data with software Review Manager 5.3.Results Thirteen observational studies with 19807 subjects were included.Among them,11662 patients were treated with dual antiplatelet therapy and the other 6251 were treated with triple antithrombotic therapy.All included studies were high quality literature with NOS score 6-9.Pooled results are as follows: 1)compared with the DAPT group,the TT group can significantly increase the risk of major bleeding(OR=0.66,95%CI(0.53,0.83),P=0.0003),when limited to the Asian patients,the difference was not statistically significant(OR=0.57,95% CI(0.19,1.77),P=0.33);2)the risk of myocardial infarction was comparable between TT and DAPT group(OR=1.23,95%CI(0.85,1.77),P=0.27),when limited to the Asian patients,the TT group can significantly reduce the risk of myocardial infarction(OR=2.16,95%CI(1.32,3.53),P=0.002);3)to patients with a long period of follow-up,the incidence of stroke was comparable between the two groups(OR=1.02,95% CI(0.81,1.27),P=0.88);to patients with a short follow-up,TT can significantly reduce the incidence of stroke(OR=2.42,95% CI(1.76,3.32),P<0.00001);4)the risk of all-cause mortality was comparable between TT and DAPT group(OR=1.36,95%CI(0.98,1.90),P=0.07);5)TT can reduce the incidence of stent thrombosis,but the difference was not statistically significant(OR=1.92;95%CI(0.98,3.75),P=0.06)Conclusion compared with the DAPT group,the TT group can reduce the incidence of stent thrombosis,while the difference was not statistically significant,but it can significantly increase the risk of major bleeding.The risk of myocardial infarction,stroke and all-cause mortality was comparable between the two groups.It indicated that DAPT may be safer than TT.