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Am J Cardiol. 2019;124(6):879-885.

Meta-Analysis of Oral Anticoagulant Monotherapy as an Antithrombotic Strategy in Patients With Stable Coronary Artery Disease and Nonvalvular Atrial Fibrillation.

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제1저자 이소령, 이태민 · 교신저자 오세일, 그레고리 립

소속 (4)
  1. Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
  2. Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
  3. Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: seil@snu.ac.kr.
  4. Liverpool Centre for Cardiovascular Science, Liverpool Chest & Heart Hospital, University of Liverpool, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address: Gregory.Lip@liverpool.ac.uk.

Abstract

Guidelines recommend oral anticoagulant (OAC) monotherapy without antiplatelet therapy (APT) in patients with nonvalvular atrial fibrillation (AF) with stable coronary artery disease (CAD) of >1 year after myocardial infarction or percutaneous coronary intervention. More evidences are required for the safety and efficacy of OAC monotherapy compared with OAC plus APT. PubMed, EMBASE, and Cochrane Database of Systematic Reviews were systematically searched up to February 2019. Nonrandomized studies and randomized clinical trials comparing OAC monotherapy with OAC plus single APT (SAPT) for patients with stable CAD and nonvalvular AF. The primary end point was major adverse cardiovascular events (composite of ischemic or thrombotic events) and secondary outcomes included major bleeding, stroke, all-cause death, and net adverse events (composite of ischemic, thrombotic, or bleeding events). From 6 trials, 8,855 patients were included. There was no significant difference in major adverse cardiovascular event in patients with AF treated using OAC plus SAPT compared with those treated with OAC monotherapy (hazard ratio [HR] 1.09; 95% confidence interval [CI] 0.92 to 1.29). OAC plus SAPT was associated with a significantly higher risk of major bleeding compared with OAC monotherapy (HR 1.61; 95% CI 1.38 to 1.87), as well as in terms of net adverse event (HR 1.21; 95% CI 1.02 to 1.43). There were no significant differences in rates of stroke and all-cause death. In conclusion, in this meta-analysis, OAC monotherapy and OAC plus SAPT treatment showed similar effectiveness, but OAC monotherapy was significantly associated with a lower risk of bleeding compared with OAC plus SAPT in patients with nonvalvular AF and stable CAD.

Copyright © 2019 Elsevier Inc. All rights reserved.

그 밖의 정보
출판 형태
Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review
저널
The American journal of cardiology · eISSN 1879-1913
전자 출판
2019-06-25
MeSH
Administration, Oral · Anticoagulants / administration & dosage · Atrial Fibrillation / complications / drug therapy · Coronary Artery Disease / complications / drug therapy · Humans · Practice Guidelines as Topic* · Thrombolytic Therapy / standards · Treatment Outcome
Substances
Anticoagulants