| Objective:To systemically evaluate the efficacy and safety of warfarin combined with single antiplatelet therapy(dual therapy,DT)versus warfarin combined with dual antiplatelet therapy(triple therapy,TT)in patients with atrial fibrillation(AF)after percutaneous coronary intervention(PCI).Methods:Pub Med,EMBASE and The Cochrane library databases were searched for relevant studies comparing triple therapy(TT)and dual therapy(DT)in patients with AF who underwent PCI.These databases were searched up to December-30-2017,and searching by manually filtering article references to avoid missed detection.The effective endpoints were myocardial infarction(MI),stroke,major adverse cardiovascular event(MACE),all-cause mortality,stent thrombosis,the safety endpoint was major bleeding.Rev Man 5.3 software was used for statistical analysis.Results:Six studies with 8618 patients were included [TT: 3,619(42%),DT : 4999(58%)].The risk of MI and stroke was significantly lower in the TT group than that of DT group at a mean follow – up period of 1 year(OR = 0.54,95% CI: 0.39-0.77,P = 0.0005;OR = 0.44,95% CI: 0.30-0.65,P < 0.0001).The MACE,all-cause mortality,and stent thrombosis in the DT group was comparable with those in the TT group(OR = 0.97,95% CI: 0.57-1.66,P = 0.91;OR = 0.64,95% CI: 0.31-1.29,P = 0.21 and OR = 0.47,95% CI: 0.13-1.72,P = 0.25).The results of the safety endpoint showed that the incidence of major bleeding at 1 year was 8.6% in the TT group and 8.9% in the DT group(VKA + AA)group.The risk of bleeding was similar between both groups(OR = 0.97,95% CI: 0.74-1.28,P = 0.85).Conclusion: The results of this study showed that triple antithrombotic therapy for patients with arrial after percutaneous coronary intervention could significantly reduce stroke and myocardial infarction,but the risk of major bleeding was not lower in patients with dual antithrombotic than triple antithrombotic therapy. |
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