Evidence map›Paper›PMID 33119069›Full record

SynthesisEuropean heart journal. Cardiovascular pharmacotherapy2021

Safety and efficacy of double vs. triple antithrombotic therapy in patients with atrial fibrillation with or without acute coronary syndrome undergoing percutaneous coronary intervention: a collaborative meta-analysis of non-vitamin K antagonist oral anticoagulant-based randomized clinical trials.

Giuseppe Gargiulo, Christopher P Cannon, Charles Michael Gibson, Andreas Goette, Renato D Lopes, Jonas Oldgren, Serge Korjian, Stephan Windecker, Giovanni Esposito, Pascal Vranckx and 1 more

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal. Cardiovascular pharmacotherapy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 pooled it
4.2field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Review
  4. Article
  5. Review
  6. Review
  7. Review
  8. Observational
  9. Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023
    Review
  10. Dual versus triple antithrombotic therapy after percutaneous coronary intervention: the prospective multicentre WOEST 2 Study.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2022
    Article
  11. Article
  12. Review
  13. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2021
    Article
  14. Article
  15. Article
  16. Consolidating the value of the standardised ARC-HBR definition.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2021
    Article
  17. Global & regional health technology assessment
    Review
  18. Left Ventricular Thrombus in Oncology Patients and Beyond: Imaging, Treatment Choices, and Duration.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 8 institutions in 6 countries.

Giuseppe GargiuloDepartment of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Christopher P CannonCardiovascular Division, Brigham and Women's Hospital, Heart and Vascular Center and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Charles Michael GibsonDivision of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Andreas GoetteSt. Vincenz-Hospital, Am Busdorf 2, 33098 Paderborn, Germany.
Renato D LopesDuke Clinical Research Institute, Duke University School of Medicine, 200 Morris Street, Durham, NC 27701, USA.
Jonas OldgrenUppsala Clinical Research Center and, Department of Medical Sciences, Uppsala University, Dag Hammarskjolds vag 38, SE-751 85 Uppsala, Sweden.
Serge KorjianDivision of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Stephan WindeckerDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3030 Bern, Switzerland.
Giovanni EspositoDepartment of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Pascal VranckxDepartment of Cardiology and Intensive Care Medicine, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences, Hasselt University, Stadsomvaart 11, 3500 Hasselt, Belgium.
Marco ValgimigliDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3030 Bern, Switzerland.
Beth Israel Deaconess Medical Center · USUniversity of Bern · CHUniversity of Naples Federico II · ITAtrial Fibrillation NETwork · DEBrigham and Women's Hospital · USDuke University · USJessa Hospital · BEUppsala University · SE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsSafety and efficacy of antithrombotic regimens in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) may differ based on clinical presentation. We sought to compare double vs. triple antithrombotic therapy (DAT vs. TAT) in AF patients with or without acute coronary syndrome (ACS) undergoing PCI. METHODS AND

resultsA systematic review and meta-analysis was performed using PubMed to search for non-vitamin K antagonist oral anticoagulant (NOAC)-based randomized clinical trials. Data on subgroups of ACS or elective PCI were obtained by published reports or trial investigators. A total of 10 193 patients from four NOAC trials were analysed, of whom 5675 presenting with ACS (DAT = 3063 vs. TAT = 2612) and 4518 with stable coronary artery disease (SCAD; DAT = 2421 vs. TAT = 2097). The primary safety endpoint of ISTH major bleeding or clinically relevant non-major bleeding was reduced with DAT compared with TAT in both ACS (12.2% vs. 19.4%; RR 0.63, 95% CI 0.56-0.71; P < 0.0001; I2 = 0%) and SCAD (14.6% vs. 22.0%; RR 0.68, 95% CI 0.55-0.85; P = 0.0008; I2 = 66%), without interaction (P-int = 0.54). Findings were consistent for secondary bleeding endpoints, including intra-cranial haemorrhage. In both subgroups, there was no difference between DAT and TAT for all-cause death, major adverse cardiovascular events, or stroke. Myocardial infarction and stent thrombosis were numerically higher with DAT vs. TAT consistently in ACS and SCAD (P-int = 0.60 and 0.86, respectively). Findings were confirmed by multiple sensitivity analyses, including a separate analysis on dabigatran regimens and a restriction to PCI population.

conclusionsDAT, compared with TAT, is associated with lower bleeding risks, including intra-cranial haemorrhage, and a small non-significant excess of cardiac ischaemic events in both patients with or without ACS.

Indexed as

Acute Coronary SyndromeAtrial FibrillationPercutaneous Coronary InterventionAnticoagulantsFibrinolytic AgentsHumansPlatelet Aggregation InhibitorsRandomized Controlled Trials as TopicAnticoagulantsFibrinolytic AgentsPlatelet Aggregation InhibitorsAcute coronary syndrome (ACS)Atrial fibrillation (AF)Double therapy (DAT)Non-vitamin K antagonist oral anticoagulant (NOAC)Percutaneous coronary intervention (PCI)Triple therapy (TAT)

Identifiers

PMID33119069
PMCPMC8117456
OpenAlexW3096928241

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.