Among patients with atrial fibrillation (AF) and stable ischemic heart disease (SIHD), the addition of a single antiplatelet agent (SAPT) to oral anticoagulation (OAC) monotherapy did not result in a statistically significant decrease in thrombotic complications. Furthermore, OAC monotherapy was linked to fewer bleeding events. These findings were presented during the American College of Cardiology Annual Meeting held virtually May 15 to 17, 2021.

Researchers from the University of Oklahoma and Mayo Clinic searched publication databases for studies of OAC therapies among patients with AF and SIHD. A systematic review and meta-analysis were performed using data from 20 observational studies and 2 randomized controlled trials comprising 48,419 patients.

The 2 randomized trials found that OAC and a single antiplatelet agent (SAPT) dual therapy increased risk for major bleeding events (risk ratio [RR], 1.51; 95% CI, 1.10-2.06) compared with OAC monotherapy.


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OAC and SAPT dual therapy was not associated with altered risk for major adverse cardiovascular events (RR, 1.10; 95% CI, 0.71-1.72), strokes (RR, 1.29; 95% CI, 1.95), myocardial infarctions (RR, 0.57; 95% CI, 0.28-1.16), cardiovascular mortality (RR, 1.22; 95% CI, 0.63-2.35), or all-cause mortality (RR, 1.18; 95% CI, 0.52-2.68).

Among the observational studies, OAC and SAPT dual therapy was associated with increased risk for major bleeding events (RR, 1.51; 95% CI, 1.40-1.63), total bleeding events (RR, 1.50; 95% CI, 1.20-1.88), or myocardial infarctions (RR, 1.14; 95% CI, 1.04-1.25) compared with monotherapy.

OAC and SAPT dual therapy was not associated with increased risk for major adverse cardiovascular events (RR, 1.11; 95% CI, 0.96-1.28), strokes (RR, 0.92; 95% CI, 0.68-1.24), cardiovascular mortality (RR, 1.14; 95% CI, 0.97-1.34), or all-cause mortality (RR, 0.94; 95% CI, 0.76-1.16).

Similar results were observed among subgroups of patients on vitamin K antagonists or direct OACs.

The study authors did not test for potential bias among underlying studies. It remains unclear to what extent study heterogeneity may be impacting these findings.

These data indicated bleeding events were decreased among patients with AF and SIHD comorbidities treated with OAC monotherapy.

Reference

Shakir A, Khan A, Clifton S, Reese J, Deshmukh A, Asad ZUA. Oral anticoagulant monotherapy vs oral anticoagulation with single antiplatelet therapy in patients with atrial fibrillation and stable ischemic heart disease: A systematic review and meta-analysis. Presented at: American College of Cardiology Annual Meeting; May 15-17, 2021.