Meta-Analysis of Trials Comparing Oral Anticoagulation and Aspirin versus Dual Antiplatelet Therapy after Coronary Stenting

• Published in: Cardiology Vol. 104; no. 2; pp. 101 - 106
• Main Authors: Rubboli, Andrea, Milandri, Milena, Castelvetri, Cristina, Cosmi, Benilde
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland 2005
• Subjects: Review Article; Aspirin; Coronary angioplasty; Coronary stent; Antiplatelets; Oral anticoagulants; Ticlopidine
• ISSN: 0008-6312; 1421-9751
• DOI: 10.1159/000086918

The combination of oral anticoagulation (OAC) and aspirin was the antithrombotic treatment initially adopted after coronary stenting (PCI-S). Although dual antiplatelet therapy with aspirin and a thienopyridine subsequently proved safer and more effective, OAC and aspirin combination is still used in patients with an indication for long-term OAC undergoing PCI-S. The absolute (AR) and relative (RR) risk of cardiac events and hemorrhagic/vascular complications of OAC and aspirin versus antiplatelet therapy were evaluated in a meta-analysis of four historical clinical trials. In 2,436 patients, the RR of a 30-day primary composite endpoint of death, myocardial infarction and the need for revascularization was significantly reduced by antiplatelet therapy (RR 0.41; 95% CI 0.25–0.69), whereas the RR of stent thrombosis (RR 0.26; 95% CI 0.06–1.14) and major bleeding (RR 0.36; 95% CI 0.14–1.02) was not statistically different. The 30-day AR of death, myocardial infarction, need for revascularization, major bleedings and vascular complications with OAC and aspirin were 0.65, 3.8, 4.2, 6.4 and 6.6%, respectively. In conclusion, due to the low AR of adverse events, the combination of OAC and aspirin appears an acceptable treatment after PCI-S in patients in whom long-term OAC is deemed mandatory.