1
|
Wang S, Liu Y, Wang L, Zuo H, Tian Y, Wang Y, Yin D, Zhang H, Tian Y. Optimisation of oral anticoagulants for patients with atrial fibrillation within 12 months after percutaneous coronary intervention: A meta-analysis and systematic review. IJC HEART & VASCULATURE 2021; 36:100850. [PMID: 34401468 PMCID: PMC8349768 DOI: 10.1016/j.ijcha.2021.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal antithrombotic strategy, especially regarding oral anticoagulants (OACs) for atrial fibrillation (AF) patients with bleeding and thrombosis risk after percutaneous coronary intervention (PCI), remains unknown. This study explored the optimal oral anticoagulants for AF patients after PCI using a meta-analysis. METHODS Randomised controlled trials were identified from PubMed, Embase, and the Cochrane Library through December 2020. Risk ratios, 95% confidence intervals, and random-effects models were used to compare different antithrombotic strategies through network meta-analysis, and the combination of antithrombotic agents was ranked according to the surface under the cumulative ranking curve and rankograms. Interval plots were drawn to observe pairwise comparisons between the different strategies. RESULTS Five studies of 11,532 patients were included. Factor IIa inhibitor 110 mg bid plus a P2Y12 inhibitor had the greatest advantage for reducing Thrombolysis In Myocardial Infarction (TIMI) major or minor bleeding; Factor Xa inhibitor plus a P2Y12 inhibitor had the greatest advantage for reducing International Society on Thrombosis and Hemostasis major bleeding. For patients at risk of stroke plus all-cause death, factor IIa inhibitor 150 mg bid plus a P2Y12 inhibitor should be prioritised, and for those at risk of myocardial infarction and stent thrombosis, vitamin K antagonists plus a P2Y12 inhibitor were preferred. CONCLUSION Factor IIa inhibitor 110 mg, factor IIa inhibitor 150 mg, factor Xa inhibitor and vitamin K antagonists should be selected in different situations.
Collapse
Key Words
- 95% CI, 95% confidence intervals
- AF, Atrial fibrillation
- Antithrombotic therapy
- Atrial fibrillation
- DAT, Oral anticoagulants plus single antiplatelet therapy
- IIa, Factor IIa
- ISTH, International Society on Thrombosis and Hemostasis
- MI, Myocardial infarction
- NOACs, Novel oral anticoagulants
- OACs, Oral anticoagulants
- Oral anticoagulant
- PCI, Percutaneous coronary intervention
- Percutaneous coronary intervention
- RR, Risk ratios
- SD, Standard deviation
- SUCRA, Surface under the cumulative ranking curve
- TAT, Vitamin K antagonist plus a P2Y12 inhibitor and aspirin
- TIMI, Thrombolysis In Myocardial Infarction
- VKA, Vitamin K antagonist
- Xa, Factor Xa
Collapse
Affiliation(s)
- Shuo Wang
- Department of Pathophysiology and Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Key Laboratory of Cardiovascular Research (Harbin Medical University), Ministry of Education, Harbin 150086, PR China
- Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Ying Liu
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Linxin Wang
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Haiqi Zuo
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Yanfeng Tian
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Yimeng Wang
- Department of Pathophysiology and Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Key Laboratory of Cardiovascular Research (Harbin Medical University), Ministry of Education, Harbin 150086, PR China
- Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Dechun Yin
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Haiyu Zhang
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Ye Tian
- Department of Pathophysiology and Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Key Laboratory of Cardiovascular Research (Harbin Medical University), Ministry of Education, Harbin 150086, PR China
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| |
Collapse
|