Dual antithrombotic therapy with DOACs after ACS or PCI in Atrial Fibrillation: A meta-analysis of Randomized Controlled Trials

Abstract Background The choice of antithrombotic therapy for atrial fibrillation (AF) patients who have an acute coronary syndrome (ACS) or have undergone percutaneous coronary intervention (PCI) is challenging. We aimed to assess outcomes between dual antithrombotic therapy with DOACs plus an antiplatelet agent (Dual therapy) in comparison to warfarin plus two antiplatelet agents (Triple therapy) after PCI or ACS for AF patients. Methods Systematic searches of multiple major databases were performed from inception until September 2019. We included only randomized controlled trials. Odd ratios were pooled using a random-effects model. Results We identified 4 RCTs, which included 7168 patients. In comparison to triple antithrombotic therapy with warfarin, Dual antithrombotic therapy with DOACs was associated with a significant reduction in major bleeding (odds ratio [OR] 0.56 [95% confidence interval [CI] 0.38 to 0.82], p 0.003) as well as major bleeding or clinically relevant non-major bleeding (OR 0.53 [95% CI 0.38 to 0.75], p Conclusions In patients with AF and recent ACS or PCI, the use of dual antithrombotic therapy with DOACs was associated with less major bleeding, and major bleeding or clinically relevant non-major bleeding, compared to triple therapy. The use of dual therapy also shows non-significantly higher composite of death/ischemic events but no difference in mortality.