Antiplatelet therapy in patients with atrial fibrillation: a systematic review and meta-analysis of randomized trials
| Autor: | Willem J M Dewilde, William F. McIntyre, Jeff S. Healey, Samantha Sartori, Satoshi Yasuda, Ashkan Shoamanesh, Renato D. Lopes, Stuart J. Connolly, Alexander P Benz, Isabelle Johansson, Nikolaus Sarafoff, Roxana Mehran, John W. Eikelboom |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
MEDLINE Myocardial Infarction Hemorrhage 030204 cardiovascular system & hematology law.invention Brain Ischemia 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine Atrial Fibrillation Medicine Humans Pharmacology (medical) 030212 general & internal medicine Myocardial infarction Stroke Randomized Controlled Trials as Topic Aspirin business.industry Anticoagulants Atrial fibrillation medicine.disease Confidence interval 3. Good health Relative risk Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | European heart journal. Cardiovascular pharmacotherapy. 8(7) |
| ISSN: | 2055-6845 |
| Popis: | Aims The aim of this study was to systematically assess the effects of antiplatelets on clinical outcomes in patients with atrial fibrillation (AF), treated and not-treated with oral anticoagulation. Methods and results We searched MEDLINE, Embase, and CENTRAL from inception until September 2020. From 5446 citations, we selected randomized trials allocating patients with AF to antiplatelet therapy vs. control. We applied random-effects models for meta-analysis and assessed potential effect modification with background anticoagulation use. Eighteen trials including 21 518 participants met our prespecified eligibility criteria. In 10 studies without background anticoagulation, antiplatelets reduced all-cause stroke [486/6165 (events/patients) vs. 621/6061; risk ratio (RR) 0.77, 95% confidence interval (CI) 0.69–0.86, I2 = 0%]. In eight studies with background anticoagulation, there was a signal for an increase in all-cause stroke with antiplatelets (97/4608 vs. 72/4684; RR 1.33, 95% CI 0.98–1.79, I2 = 0%, P-value for interaction Conclusions In patients with AF not receiving oral anticoagulation, antiplatelet therapy modestly reduced stroke. There was a corresponding signal for harm when used on top of anticoagulation. Irrespective of background anticoagulation use, antiplatelet therapy significantly increased bleeding, moderately reduced myocardial infarction, and did not affect mortality. |
| Databáze: | OpenAIRE |
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