0
Original Research: ANTITHROMBOTIC THERAPY |

“Triple Therapy” Rather Than “Triple Threat”: A Meta-analysis of the Two Antithrombotic Regimens After Stent Implantation in Patients Receiving Long-term Oral Anticoagulant Treatment

Hong-Jin Zhao, MD; Zhao-Tong Zheng, MD; Zhi-Hao Wang, MD; Shao-Hua Li, MD; Yun Zhang, MD; Ming Zhong, MD; Wei Zhang, MD
Author and Funding Information

From the Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health; and the Department of Cardiology, Qilu Hospital of Shandong University, Ji’nan, Republic of China.

Correspondence to: Ming Zhong, MD, Department of Cardiology, Qilu Hospital of Shandong University, Ji’nan 250012, ROC; e-mail: zhongmingzm@gmail.com


For editorial comment see page 240

Drs Zhao and Zheng contributed equally to this work.

Funding/Support: This work was supported by research grants from Key Technologies R and D Program of Shandong Province [2006GG2202020], the Natural Science Foundation of Shandong Province [Y2005C11, ZR2009CM022, and 2009ZRB019CQ], the National Natural Science Foundation of China [30670874, 30570748, 30871038, and 30971215], and the National Basic Research Program of China [973 Program, Grant 2009CB521904].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(2):260-270. doi:10.1378/chest.09-3083
Text Size: A A A
Published online

Background:  An increasing number of patients with an indication for long-term oral anticoagulation (OAC) have undergone percutaneous coronary intervention with stent implantation (PCI-s). However, the optimal antithrombotic treatment for these patients is currently unknown. The purpose of this study was to characterize the benefits and risks of triple antithrombotic therapy (combined aspirin, clopidogrel, and OAC) after stent implantation in patients under long-term OAC treatment compared with dual antiplatelet therapy (combined aspirin and clopidogrel).

Methods:  The study consisted of clinical controlled trials with ≥ 3 months of follow-up that compared triple antithrombotic therapy with dual antiplatelet therapy after stent implantation in patients undergoing long-term OAC treatment.

Results:  Nine clinical trials included 1,996 participants. The meta-analysis was feasible because the grouping criterion was similar. The meta-analysis of the prevention of a major adverse cardiovascular event shows triple antithrombotic therapy to be more efficacious than dual antiplatelet therapy (OR, 0.60; 95% CI, 0.42-0.86; P = .005). There was a significant reduction in all-cause mortality with triple antithrombotic therapy compared with dual antiplatelet therapy. The meta-analysis of major bleeding in the first 6 months during follow-up shows significantly more events with triple antithrombotic therapy (OR, 2.12; 95% CI, 1.05-4.29; P = .04).

Conclusions:  Based on our analysis, triple antithrombotic therapy is substantially more efficacious in reducing the occurrence of cardiovascular events and mortality in PCI-s patients with an indication for long-term OAC, compared with dual antiplatelet therapy. Although triple therapy predisposes patients to an increased risk of bleeding, especially major bleeding, it is the better choice for patients with a low bleeding risk.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
Antithrombotic Therapy for Non–ST-Segment Elevation Acute Coronary Syndromes*: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
The Perioperative Management of Antithrombotic Therapy*: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543