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Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta-analysis of 16 Clinical Trials and 9,185 Patients
The optimal antithrombotic regimen remains controversial in patients taking oral anticoagulation (OAC) undergoing coronary stenting. This study sought to compare efficacy and safety outcomes of triple therapy (OAC, aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or OAC) in these...
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Published in: | Clinical cardiology (Mahwah, N.J.) N.J.), 2015-08, Vol.38 (8), p.499-509 |
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creator | Gao, Xiao-Fei Chen, Yan Fan, Zhong-Guo Jiang, Xiao-Min Wang, Zhi-Mei Li, Bing Mao, Wen-Xing Zhang, Jun-Jie Chen, Shao-Liang |
description | The optimal antithrombotic regimen remains controversial in patients taking oral anticoagulation (OAC) undergoing coronary stenting. This study sought to compare efficacy and safety outcomes of triple therapy (OAC, aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or OAC) in these patients. We hypothesize OAC plus clopidogrel could be the optimal regimen for patients with indications for OAC receiving stent implantation. Medline, the Cochrane Library, and other Internet sources were searched for clinical trials comparing the efficacy and safety of triple vs dual therapy for patients taking OAC after coronary stenting. Sixteen eligible trials including 9185 patients were identified. The risks of major adverse cardiac events (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.82-1.39, P = 0.65), all-cause mortality (OR: 0.98, 95% CI: 0.76-1.27, P = 0.89), myocardial infarction (OR: 1.01, 95% CI: 0.77-1.31, P = 0.97), and stent thrombosis (OR: 0.91, 95% CI: 0.49-1.69, P = 0.75) were similar between triple and dual therapy. Compared with dual therapy, triple therapy was associated with a reduced risk of ischemic stroke (OR: 0.57, 95% CI: 0.35-0.94, P = 0.03) but with higher major bleeding (OR: 1.52, 95% CI: 1.11-2.10, P = 0.01) and minor bleeding (OR: 1.59, 95% CI: 1.05-2.42, P = 0.03). Subgroup analysis indicated there were similar ischemic stroke and major bleeding outcomes between triple therapy and therapy with OAC plus clopidogrel. Treatment with OAC and clopidogrel was associated with similar efficacy and safety outcomes compared with triple therapy. Triple therapy could be replaced by OAC plus clopidogrel without any concern about additional risk of thrombotic events. |
doi_str_mv | 10.1002/clc.22411 |
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This study sought to compare efficacy and safety outcomes of triple therapy (OAC, aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or OAC) in these patients. We hypothesize OAC plus clopidogrel could be the optimal regimen for patients with indications for OAC receiving stent implantation. Medline, the Cochrane Library, and other Internet sources were searched for clinical trials comparing the efficacy and safety of triple vs dual therapy for patients taking OAC after coronary stenting. Sixteen eligible trials including 9185 patients were identified. The risks of major adverse cardiac events (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.82-1.39, P = 0.65), all-cause mortality (OR: 0.98, 95% CI: 0.76-1.27, P = 0.89), myocardial infarction (OR: 1.01, 95% CI: 0.77-1.31, P = 0.97), and stent thrombosis (OR: 0.91, 95% CI: 0.49-1.69, P = 0.75) were similar between triple and dual therapy. Compared with dual therapy, triple therapy was associated with a reduced risk of ischemic stroke (OR: 0.57, 95% CI: 0.35-0.94, P = 0.03) but with higher major bleeding (OR: 1.52, 95% CI: 1.11-2.10, P = 0.01) and minor bleeding (OR: 1.59, 95% CI: 1.05-2.42, P = 0.03). Subgroup analysis indicated there were similar ischemic stroke and major bleeding outcomes between triple therapy and therapy with OAC plus clopidogrel. Treatment with OAC and clopidogrel was associated with similar efficacy and safety outcomes compared with triple therapy. Triple therapy could be replaced by OAC plus clopidogrel without any concern about additional risk of thrombotic events.</description><identifier>EISSN: 1932-8737</identifier><identifier>DOI: 10.1002/clc.22411</identifier><identifier>PMID: 25963316</identifier><language>eng</language><publisher>United States</publisher><subject>Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Anticoagulants - therapeutic use ; Drug Therapy, Combination ; Female ; Fibrinolytic Agents - administration & dosage ; Fibrinolytic Agents - adverse effects ; Fibrinolytic Agents - therapeutic use ; Humans ; Male ; Percutaneous Coronary Intervention - adverse effects ; Treatment Outcome</subject><ispartof>Clinical cardiology (Mahwah, N.J.), 2015-08, Vol.38 (8), p.499-509</ispartof><rights>2015 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25963316$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gao, Xiao-Fei</creatorcontrib><creatorcontrib>Chen, Yan</creatorcontrib><creatorcontrib>Fan, Zhong-Guo</creatorcontrib><creatorcontrib>Jiang, Xiao-Min</creatorcontrib><creatorcontrib>Wang, Zhi-Mei</creatorcontrib><creatorcontrib>Li, Bing</creatorcontrib><creatorcontrib>Mao, Wen-Xing</creatorcontrib><creatorcontrib>Zhang, Jun-Jie</creatorcontrib><creatorcontrib>Chen, Shao-Liang</creatorcontrib><title>Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta-analysis of 16 Clinical Trials and 9,185 Patients</title><title>Clinical cardiology (Mahwah, N.J.)</title><addtitle>Clin Cardiol</addtitle><description>The optimal antithrombotic regimen remains controversial in patients taking oral anticoagulation (OAC) undergoing coronary stenting. This study sought to compare efficacy and safety outcomes of triple therapy (OAC, aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or OAC) in these patients. We hypothesize OAC plus clopidogrel could be the optimal regimen for patients with indications for OAC receiving stent implantation. Medline, the Cochrane Library, and other Internet sources were searched for clinical trials comparing the efficacy and safety of triple vs dual therapy for patients taking OAC after coronary stenting. Sixteen eligible trials including 9185 patients were identified. The risks of major adverse cardiac events (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.82-1.39, P = 0.65), all-cause mortality (OR: 0.98, 95% CI: 0.76-1.27, P = 0.89), myocardial infarction (OR: 1.01, 95% CI: 0.77-1.31, P = 0.97), and stent thrombosis (OR: 0.91, 95% CI: 0.49-1.69, P = 0.75) were similar between triple and dual therapy. Compared with dual therapy, triple therapy was associated with a reduced risk of ischemic stroke (OR: 0.57, 95% CI: 0.35-0.94, P = 0.03) but with higher major bleeding (OR: 1.52, 95% CI: 1.11-2.10, P = 0.01) and minor bleeding (OR: 1.59, 95% CI: 1.05-2.42, P = 0.03). Subgroup analysis indicated there were similar ischemic stroke and major bleeding outcomes between triple therapy and therapy with OAC plus clopidogrel. Treatment with OAC and clopidogrel was associated with similar efficacy and safety outcomes compared with triple therapy. Triple therapy could be replaced by OAC plus clopidogrel without any concern about additional risk of thrombotic events.</description><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulants - therapeutic use</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Fibrinolytic Agents - adverse effects</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Humans</subject><subject>Male</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Treatment Outcome</subject><issn>1932-8737</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNo9kM1OwzAQhC0kREvhwAsgHzmQEq9jJ-EWVfxUKipCuUeOaxdDYhc7QeqL8LwYUTitVt_MrGYRuiDpnKQp3MhOzgEyQo7QlJQUkiKn-QSdhvAWcVoAPUETYCWnlPAp-qrsYIZX7_rWDUbiF7U1vbIBa-fxsxiMskPAtXg3dovXXnT4xyCd2I5dpM7iSg_K44Xzzgq_x0sb18_oiuwWV_hJDSIRVnT7YAJ2GhOOF52xRsas2hvRBSzsBpfXpGD_F8_QsY5EnR_mDNX3d_XiMVmtH5aLapXsGOeJzoG1tBWcgZYkE4XWkHNZsjbdQJoRBhkrWEZLAkILxTVIyBQrocihKDjQGbr6jd159zGqMDS9CVJ1nbDKjaEhecpyGkNIlF4epGPbq02z86aPfZu_V9JvORtyzw</recordid><startdate>201508</startdate><enddate>201508</enddate><creator>Gao, Xiao-Fei</creator><creator>Chen, Yan</creator><creator>Fan, Zhong-Guo</creator><creator>Jiang, Xiao-Min</creator><creator>Wang, Zhi-Mei</creator><creator>Li, Bing</creator><creator>Mao, Wen-Xing</creator><creator>Zhang, Jun-Jie</creator><creator>Chen, Shao-Liang</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201508</creationdate><title>Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta-analysis of 16 Clinical Trials and 9,185 Patients</title><author>Gao, Xiao-Fei ; Chen, Yan ; Fan, Zhong-Guo ; Jiang, Xiao-Min ; Wang, Zhi-Mei ; Li, Bing ; Mao, Wen-Xing ; Zhang, Jun-Jie ; Chen, Shao-Liang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p566-f725b3ba652fc14a8ff276c95b0d204152458543912afae6f2c24e59287288623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - adverse effects</topic><topic>Anticoagulants - therapeutic use</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Fibrinolytic Agents - adverse effects</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Humans</topic><topic>Male</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gao, Xiao-Fei</creatorcontrib><creatorcontrib>Chen, Yan</creatorcontrib><creatorcontrib>Fan, Zhong-Guo</creatorcontrib><creatorcontrib>Jiang, Xiao-Min</creatorcontrib><creatorcontrib>Wang, Zhi-Mei</creatorcontrib><creatorcontrib>Li, Bing</creatorcontrib><creatorcontrib>Mao, Wen-Xing</creatorcontrib><creatorcontrib>Zhang, Jun-Jie</creatorcontrib><creatorcontrib>Chen, Shao-Liang</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical cardiology (Mahwah, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gao, Xiao-Fei</au><au>Chen, Yan</au><au>Fan, Zhong-Guo</au><au>Jiang, Xiao-Min</au><au>Wang, Zhi-Mei</au><au>Li, Bing</au><au>Mao, Wen-Xing</au><au>Zhang, Jun-Jie</au><au>Chen, Shao-Liang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta-analysis of 16 Clinical Trials and 9,185 Patients</atitle><jtitle>Clinical cardiology (Mahwah, N.J.)</jtitle><addtitle>Clin Cardiol</addtitle><date>2015-08</date><risdate>2015</risdate><volume>38</volume><issue>8</issue><spage>499</spage><epage>509</epage><pages>499-509</pages><eissn>1932-8737</eissn><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-1</notes><notes>content type line 23</notes><abstract>The optimal antithrombotic regimen remains controversial in patients taking oral anticoagulation (OAC) undergoing coronary stenting. This study sought to compare efficacy and safety outcomes of triple therapy (OAC, aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or OAC) in these patients. We hypothesize OAC plus clopidogrel could be the optimal regimen for patients with indications for OAC receiving stent implantation. Medline, the Cochrane Library, and other Internet sources were searched for clinical trials comparing the efficacy and safety of triple vs dual therapy for patients taking OAC after coronary stenting. Sixteen eligible trials including 9185 patients were identified. The risks of major adverse cardiac events (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.82-1.39, P = 0.65), all-cause mortality (OR: 0.98, 95% CI: 0.76-1.27, P = 0.89), myocardial infarction (OR: 1.01, 95% CI: 0.77-1.31, P = 0.97), and stent thrombosis (OR: 0.91, 95% CI: 0.49-1.69, P = 0.75) were similar between triple and dual therapy. Compared with dual therapy, triple therapy was associated with a reduced risk of ischemic stroke (OR: 0.57, 95% CI: 0.35-0.94, P = 0.03) but with higher major bleeding (OR: 1.52, 95% CI: 1.11-2.10, P = 0.01) and minor bleeding (OR: 1.59, 95% CI: 1.05-2.42, P = 0.03). Subgroup analysis indicated there were similar ischemic stroke and major bleeding outcomes between triple therapy and therapy with OAC plus clopidogrel. Treatment with OAC and clopidogrel was associated with similar efficacy and safety outcomes compared with triple therapy. Triple therapy could be replaced by OAC plus clopidogrel without any concern about additional risk of thrombotic events.</abstract><cop>United States</cop><pmid>25963316</pmid><doi>10.1002/clc.22411</doi><tpages>11</tpages></addata></record> |
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subjects | Anticoagulants - administration & dosage Anticoagulants - adverse effects Anticoagulants - therapeutic use Drug Therapy, Combination Female Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - adverse effects Fibrinolytic Agents - therapeutic use Humans Male Percutaneous Coronary Intervention - adverse effects Treatment Outcome |
title | Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta-analysis of 16 Clinical Trials and 9,185 Patients |
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