Efficacy and safety of triple antithrombotic therapy among patients with recent ACS without AF: An updated meta-analysis

Tóm tắt

Background

Acute Coronary Syndrome (ACS) remains to be a leading cause of morbidity and mortality. Several randomized clinical trials have shown the efficacy of triple antithrombotic therapy (TAT), DAPT plus DOAC, among patients with recent ACS but with increased bleeding. However, there have been newer studies which showed lower risk for bleeding. Hence, this meta-analysis will look into the efficacy and safety of TAT among patients with recent ACS without atrial fibrillation (AF).

Methods

This study used a random-effects meta-analysis using RevMan 5.4. The risk of bias was assessed using Cochrane RoB2 and the certainty of evidence was assessed using GRADE.

Results

This meta-analysis showed that TAT reduced the risk of composite MACE (RR 0.88) and myocardial infarction (MI) (RR 0.88) with a significant risk for any (RR 1.9) and major (RR 2.26) bleeding. When analyzed using the lowest dose, TAT had no significant risk reduction of composite MACE (RR 0.90) and MI (RR 0.93) but still poses significant risk for any (RR 1.57) and major (RR=2.28) bleeding.

Conclusion

Among patients with recent ACS without AF, TAT at best modestly reduces the risk for composite MACE and MI but poses a significant risk for bleeding when compared to DAPT. Further studies have to be made to ascertain the use of TAT in ACS without AF.