Coronary disease and Atrial fibrillation: Double- (1 antiplatelet, oral anticoagulation) VS Triple-therapy (2 antiplatelets, oral anticoagulation)
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2017 Oct 19;377(16):1513-1524 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
dual treatment with dabigatran 110 mg twice daily plus an a P2Y12inhibitor (clopidogrel or ticagrelor) antiplatelet
As Treatment, Chronic
Is better Than
triple therapy with dose-adjusted vitamin K antagonist plus dual antiplatelet
To reduce at 14 months major or clinically relevant bleeding events (15% dabigatran 110mg VS 27% triple therapy) with no increase of cardiovascular events (13.7% dual-therapy VS 13.4% triple-therapy)
Lancet. 2013 Mar 30;381(9872):1107-15 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
dual treatment with INR adjusted warfarin plus clopidogrel
As Treatment, Chronic
Is better Than
triple therapy with dose-adjusted vitamin K antagonist plus dual antiplatelet (aspirin + clopidogrel)
To reduce at 1 year any bleeding event (19% dual Tt VS 44% triple Tt) with no increase in the rate of thrombotic events
N Engl J Med. 2016 Dec 22;375(25):2423-2434 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
low-dose rivaroxaban (15 mg /d) plus an P2Y12 inhibitor antiplatelet for 12 months OR very-low-dose rivaroxaban (2.5 mg twice daily) plus dual antiplatelet for 1, 6, or 12 months
As Treatment, Chronic
Is better Than
dose-adjusted vitamin K antagonist plus dual antiplatelet for 1, 6, or 12 months
To reduce clinically significant bleeding (17% rivaroxaban 15 + 1 antiplatelet, 18% rivaroxaban 2.5 + 2 antiplatelets, and 26.7% antivitamin K + 2 antiplatelets) while having similar rates of cardiovascular events (6.5%, 5.6% and 6% respectively)