Efficacy and safety of triple versus dual antithrombotic therapy in atrial fibrillation and ischemic heart disease: a systematic review and meta-analysis

Wengen Zhu, Linjuan Guo, Fadi Liu, Rong Wan, Yang Shen, Gregory Y.H. Lip and Kui Hong _

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Oncotarget. 2017; 8:81154-81166. https://doi.org/10.18632/oncotarget.20870

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Wengen Zhu1,*, Linjuan Guo1,*, Fadi Liu1,*, Rong Wan2, Yang Shen2, Gregory Y.H. Lip3,# and Kui Hong1,2,#

1Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China

2Jiangxi Key Laboratory of Molecular Medicine, Nanchang of Jiangxi, China

3University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom

*These authors share co-first authorship

#These authors share co-senior authorship

Correspondence to:

Kui Hong, email: [email protected]

Keywords: atrial fibrillation, ischemic heart disease, triple therapy, dual therapy

Received: April 11, 2017     Accepted: August 26, 2017     Published: September 14, 2017


The optimal antithrombotic regimen for patients with atrial fibrillation and ischemic heart disease remains unclear. Therefore, we aimed to compare the efficacy and safety of triple therapy (TT [an anticoagulant and 2 antiplatelet drugs]) with dual therapy (DAPT [2 antiplatelet drugs] or DT [an anticoagulant and a single antiplatelet drug]) in patients with atrial fibrillation and ischemic heart disease. We systematically searched the Cochrane Library, PubMed and Embase databases for all relevant studies up to August 2017. The overall risk estimates were calculated using the random-effects model. A total of 17 observational studies were included. Regarding the efficacy outcomes, no differences were observed between the triple therapy and the dual therapy for all-cause death, cardiovascular death, or thrombotic complications (i.e., acute coronary syndrome, stent thrombosis, thromboembolism/stroke, and major adverse cardiac and cerebrovascular events). Regarding the safety outcomes, compared with DAPT, TT was associated with increased risks of major bleeding (a relative risk of 1.96 [1.40–2.74]), minor bleeding (1.69 [1.06–2.71]) and overall bleeding (1.80 [1.23–2.64]). Compared wtih DT, TT was associated with a greater risk of major bleeding (1.65 [1.23–2.21]), but rates of minor bleeding (0.99 [0.56–1.77]) and overall bleeding (1.14 [0.76–1.71]) were similar. Overall, TT confers an increased hazard of major bleeding with no thromboembolic protection compared with dual therapy in patients with atrial fibrillation and ischemic heart disease.

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