DAPT has less bleeding risk than triple therapy in patients with AF after PCI

US: Atrial fibrillation represents a serious heart rhythm disorder associated with substantial mortality and morbidity. The presence of AF is also associated with a higher incidence of stroke, heart failure or cognitive dysfunction. Various treatment modules are available based on the patients' condition at the time of presentation.

A study was published in the journal Annals of Internal Medicine regarding the effects of dual versus triple therapy on bleeding and ischemic outcomes in adults with AF after PCI(percutaneous intervention). Use of dual therapy with a direct oral anticoagulant (DOAC) plus P2Y12 inhibitor was associated with reduced risk for major bleeding compared with triple therapy with a vitamin K antagonist (VKA) plus aspirin and P2Y12 inhibitor for patients with nonvalvular atrial fibrillation after the percutaneous coronary intervention (PCI). 

Two hazards navigate while caring for patients with AF after coronary stent placement who require anticoagulation to mitigate stroke risk and antiplatelet therapy to promote stent patency. There is a need to avoid bleeding events—which are increased with combination therapy—while also avoiding ischemic events, such as stent thrombosis, myocardial infarction, and ischemic stroke.

Randomized controlled trials that compared the effects of dual versus triple therapy on bleeding, mortality, and ischemic events in adults with AF after PCI was done by the researchers from West Virginia University and Johns Hopkins University.

Four trials encompassing 7953 patients were selected. At the median follow-up of 1 year,

1)High-certainty evidence showed that dual therapy was associated with reduced risk for major bleeding compared with triple therapy.

2)Low-certainty evidence showed inconclusive effects of dual versus triple therapy on risks for all-cause mortality (RD, 0.004), cardiovascular mortality (RD, 0.001), myocardial infarction (RD, 0.003), stent thrombosis (RD, 0.003), and stroke (RD, −0.003).

3)Heterogeneity of study designs, dosages of DOACs, and types of P2Y12 inhibitors were some of the limitations of the study.

To conclude, in adults with AF after PCI, dual therapy reduces the risk for bleeding compared with triple therapy, whereas its effects on risks for death and ischemic endpoints are still unclear.

For further reading click on the following links,

http://annals.org/aim/article/doi/10.7326/M19-3763