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Optimal antithrombotic regimens for patients with atrial fibrillation undergoing percutaneous coronary intervention: An updated network meta-analysis

JAMA Mar 02, 2020

Lopes RD, Hong H, Harskamp RE, et al. - This study intended to assess the safety and efficacy of 4 antithrombotic regimens by performing an up-to-date network meta-analysis and to identify the optimal treatment for patients with AF undergoing percutaneous coronary intervention (PCI). Researchers enrolled five randomized studies (N = 11,542; WOEST, PIONEER AF-PCI, RE-DUAL PCI, AUGUSTUS, ENTRUST-AF PCI). This analysis applied the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines in this network meta-analysis, in which bayesian random-effects models were used. Between September 9, 2019, and 29, 2019, a total of 11,532 individuals were included in this study (the mean age of the individuals ranged from 70 to 72 years, 69% to 83% were male, 20% to 26% were female, and the participants were predominantly white). The outcomes of this study demonstrated that an antithrombotic regimen of vitamin K antagonists plus DAPT should generally be avoided, because regimens in which aspirin is discontinued may lead to lower bleeding risk and no difference in antithrombotic effectiveness. Without aspirin, the application of a NOAC plus a P2Y12 inhibitor may be the most favorable treatment option and the preferred antithrombotic regimen for most individuals with AF undergoing PCI.
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