Comparison of Efficacy and Safety of Anticoagulant Monotherapy and Combined Therapy of Anticoagulant and Antiplatelets in Patients With Stable Coronary Artery Disease and Atrial Fibrillation: A Meta-Analysis

Niharika Tentu; Aqsa Ijaz; Saima Batool; Rubba S Khan; Fathia Mohammed; Maryam H Khan; Qudsia I Sandhu; Neelum Ali

doi:10.7759/cureus.29772

Comparison of Efficacy and Safety of Anticoagulant Monotherapy and Combined Therapy of Anticoagulant and Antiplatelets in Patients With Stable Coronary Artery Disease and Atrial Fibrillation: A Meta-Analysis

Cureus. 2022 Sep 30;14(9):e29772. doi: 10.7759/cureus.29772. eCollection 2022 Sep.

Authors

Niharika Tentu¹, Aqsa Ijaz², Saima Batool³, Rubba S Khan⁴, Fathia Mohammed⁵, Maryam H Khan⁶, Qudsia I Sandhu⁷, Neelum Ali⁸

Affiliations

¹ Medicine, St. John's Medical College, Bangalore, IND.
² Internal Medicine, Allama Iqbal Medical College, Lahore, PAK.
³ Internal Medicine, Hameed Latif Hospital, Lahore, PAK.
⁴ Internal Medicine, Shifa International Hospital, Islamabad, PAK.
⁵ Internal Medicine, University of Gezira, Madani, SDN.
⁶ Internal Medicine, Rawalpindi Medical University, Lahore, PAK.
⁷ Medicine, Ghazi Khan Medical College Dera Ghazi Khan, Dera Ghazi Khan, PAK.
⁸ Internal Medicine, University of Health Sciences, Lahore, PAK.

Abstract

It is still uncertain whether patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) who require long-term oral anticoagulation (OAC) should also receive antiplatelet treatment (APT). This meta-analysis aims to compare the efficacy and safety of OAC alone with OAC plus APT in individuals with AF and stable CAD. The current meta-analysis was conducted as per the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE). We performed electronic searches using PubMed, EMBASE, and Cochrane Library. The efficacy outcomes assessed in this meta-analysis included cardiovascular death, myocardial infarction, stroke (ischemic and hemorrhagic), and all-cause mortality. The safety outcome included major bleeding events. A total of five studies were included in the current meta-analysis enrolling 9199 patients with stable CAD and AF. Out of these five studies, three were observational and two were randomized controlled trials (RCTs). Our study showed no significant difference between two groups in the incidence of cardiovascular mortality (Hazard ratio {HR}: 0.86, 95% confidence interval {CI}: 0.59-1.25, I-square: 44%), myocardial infarction (HR: 1.21, 95% CI: 0.73-2.01, I-square: 0%), all-cause mortality (HR: 0.95, 95% CI: 0.76-1.19, I-square: 68%) and stroke (HR: 0.83, 95% CI: 0.61-1.12, I-square: 45%). However, lower incidence of major bleeding events in patients who received OAC alone as compared to patients who received a combination of OAC and anti-platelet (HR: 1.37, 95% CI: 1.18-1.580, I-square: 78%) were found. The current meta-analysis showed that OAC monotherapy is associated with a lower incidence of major bleeding events in patients with stable CAD and AF. It is also not associated with an increased risk of all-cause mortality, cardiovascular death, stroke, and myocardial infarction.

Keywords: anti-platelet; atrial fibrillation; coronary artery disease; meta-analysis; oral anticoagulant.

Publication types

Review