We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Direct Oral Anticoagulants Combined with Antiplatelet Therapy in the Treatment of Coronary Heart Disease: An Updated Meta-analysis.
- Authors
Liu, Leiling; Lei, Hao; Hu, Jiahui; Tang, Ying; Xu, Danyan
- Abstract
Background: Direct oral anticoagulants (DOACs) combined with antiplatelet therapy for acute coronary syndrome (ACS) may reduce ischemic events, but there is no consensus on bleeding risk. Moreover, the effect of DOACs on stable coronary artery disease (CAD) needs to be elucidated. We conducted a meta-analysis to summarize the efficacy and safety of DOACs combined with antiplatelet therapy in the treatment of stable CAD and ACS. Methods: We searched PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials, then performed a systematic review of all 17 randomized controlled trials. Results: For patients with stable CAD, DOACs combined with antiplatelet therapy significantly reduced the rate of major adverse cardiovascular events (MACE) (risk ratio; 95% confidence interval: 0.88; 0.81–0.95) and ischemic stroke (0.62; 0.50–0.77), with a relatively low risk of major bleeding (1.72; 1.42–2.07). For patients with ACS, the combination of DOACs reduced the risk of MACE (0.91; 0.85–0.97), myocardial infarction (MI) (0.90; 0.83–0.98), and ischemic stroke (0.75; 0.58–0.97), accompanied by increased non-fatal bleeding events and intracranial hemorrhage (3.42; 1.76–6.65). Results were similar when restricting the analysis to phase III studies except for the rate of stroke in patients with ACS. Conclusions: Combination therapy reduced the incidence of MI in ACS patients, but the risk of bleeding from intracranial hemorrhaging outweighs the benefit of MACE driven by MI. That is due to combination therapy having no positive impact on mortality; thus, the benefit–risk balance may be more favorable in patients with stable CAD.
- Subjects
ONLINE information services; MEDICAL databases; INFORMATION storage &; retrieval systems; CONFIDENCE intervals; META-analysis; ISCHEMIC stroke; SYSTEMATIC reviews; ANTICOAGULANTS; CORONARY disease; MYOCARDIAL infarction; PLATELET aggregation inhibitors; RESEARCH funding; COMBINED modality therapy; MEDLINE
- Publication
Drugs, 2021, Vol 81, Issue 17, p2003
- ISSN
0012-6667
- Publication type
Article
- DOI
10.1007/s40265-021-01637-4