Objective To assess efficacy and safety of dual therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) with or without percutaneous coronary intervention (PCI) and evaluate the quality of evidence with respect to said outcomes based on contemporary randomized trials (RCTs). groups (RR 0.97, 95% CI 0.8,1.17). The trial sequential analysis showed strong evidence supporting reduction in bleeding from current major RCTs while being inconclusive based on MACE outcome. Conclusion Sufficient quality evidence could be ascertained from contemporary RCTs on reduced incidence of bleeding in DT patients compared to TT patients. Further adequately powered RCTs are needed to ensure non-inferiority of DT over TT with respect to MACE outcome. strong class=”kwd-title” Keywords: dual therapy, triple therapy, meta-analysis, atrial fibrillation, acute coronary syndrome Introduction The management of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) continues to be challenging in term of antithrombotic therapy choice. Triple therapy (TT) with an oral anticoagulant and dual antiplatelet medications is currently endorsed as the therapy of choice by the European guidelines in this patient population [1].?On the other hand, UNITED STATES guidelines recommend dual therapy (DT) with fresh dental anticoagulant and P2Y12 inhibitor [2].? We utilized the advanced meta-analytic properties of trial sequential evaluation (TSA) to measure the quality of obtainable proof looking at TT vs. DT from current main randomized controlled tests (RCTs). For the purpose of our evaluation, we used main adverse cardiovascular occasions (MACE) as an effectiveness result while SCH 54292 main blood loss was used as a protection result. Strategies and Components For the existing research, data was pooled from five main RCTs that compared TT and DT in AF individuals with associated ACS and/or PCI. The RCTs utilized to get data for our current evaluation included the lately released Open-label, 2×2 Factorial, Randomized Managed, Clinical Trial to judge the Protection of Apixaban vs. Supplement K Aspirin and Antagonist vs. Aspirin Placebo in Individuals with Atrial Fibrillation and Acute Coronary Symptoms or Percutaneous Coronary Treatment (AUGUSTUS) trial [3] and previously released Randomized Evaluation of Dual Antithrombotic Therapy With Dabigatran vs Triple Therapy With Warfarin in Individuals With Nonvalvular Atrial Fibrillation Going through Percutaneous Coronary Treatment (RE\DUAL PCI) trial [4], Open-Label, Randomized, Managed, Multicenter Study Discovering Two Treatment Strategies of Rivaroxaban and a Dose-Adjusted Dental Supplement K Antagonist Treatment Technique in Topics with Atrial Fibrillation who Undergo Percutaneous Coronary Treatment (PIONEER-AF PCI) trial [5], Intracoronary Stenting and Antithrombotic Regimen-Testing of the 6-Week Pitched against a 6-Month Clopidogrel Treatment Routine in Individuals With Concomitant Aspirin and Dental Anticoagulant Therapy Pursuing Drug-Eluting Stenting (ISAR-TRIPLE) trial [6], and What’s the perfect Antiplatelet and anticoagulant therapy in individuals with dental anticoagulation and coronary StenTing (WOEST) tests [7]. The relevant data was gathered into Microsoft Excel worksheet. For SCH 54292 the purpose of our evaluation, we extracted data from individuals on WNT4 150 mg of dabigatran twice a day from RE-DUAL PCI trial and on 15 mg rivaroxaban daily from PIONEER AF trial. Since our study contained pooled patient data from these RCTs, the need for institutional SCH 54292 review board was deferred. TSA can be applied to quantify the reliability of conclusions driven from meta-analysis by establishing monitoring boundaries to test the quality of evidence. By this method, if the cumulative?Z?curve crossed the TSA boundary, a sufficient level of evidence has been reached supporting the intervention. However, if the?Z?curve failed to cross the TSA boundary, evidence to reach a conclusion is insufficient and more studies are needed. We pooled the primary safety outcome of bleeding (defined as Thrombolysis in Myocardial Infarction major and minor bleeding) and the primary efficacy outcome of major adverse cardiovascular events (composite of cardiac death, stent thrombosis, stroke and myocardial infarction) using the random effect model from above RCTs comparing DT to TT at the maximum reported follow-up. We then performed TSA to maintain an overall two-sided type-I error rate at 5% and calculated the required sample size to achieve 80% power to detect a statistically significant difference. The analysis was conducted using RevMan 5.3 (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) and Copenhagen Trial Unit, version 0.9.5.10 beta..
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