The fading role of triple therapy in patients with atrial fibrillation and acute coronary syndrome: a Bayesian network meta-analysis

Excerpt

The management of patients with concomitant atrial fibrillation (AF) and acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) represents a medical dilemma. Recent US guidelines recommend dual therapy (DT) with non-vitamin K antagonist oral anticoagulants (NOACs) and P2Y12 inhibitor instead of triple therapy (TT) which includes aspirin [1]. To date there is no head-to-head comparison among NOACs with respect to bleeding and ischemic events when utilized in AF patients with ACS and/or PCI. We used the advanced meta-analytic properties of Bayesian analysis to compare different dual therapy regimen including apixaban, rivaroxaban, dabigatran, warfarin among each other and to TT with warfarin. We used study level data and pooled the primary safety outcome of bleeding (as defined by the included trial) and the primary efficacy outcome of major adverse cardiovascular events (composite of cardiac death, stent thrombosis, stroke and myocardial infarction) from available published randomized controlled trials (RCTs). Analysis was performed using NetMetaXL version 1.6.1 and WinBUGS version 1.4.3. …