{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T13:14:01Z","timestamp":1793106841440,"version":"4.5.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2019,6,14]],"date-time":"2019-06-14T00:00:00Z","timestamp":1560470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The combination of oral anticoagulation with a P2Y12 inhibitor and aspirin in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is associated with a high bleeding risk. Dual antithrombotic therapy (DAT) with omission of aspirin is a promising option to reduce bleedings, but carries a yet unknown risk of ischaemic events. We therefore sought to systematically review and analyse randomized controlled trials investigating DAT vs. triple antithrombotic therapy (TAT) in patients with AF following PCI and\/or acute coronary syndrome (ACS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>We included four trials with overall 9317 patients (5039 DAT, 4278 TAT) in our analysis. Dual antithrombotic therapy was associated with a significant reduction in thrombolysis in myocardial infarction major bleeding [hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.42\u20130.65; P\u2009=\u20090.0001], while the composite trial-defined ischaemic endpoint did not differ significantly between DAT and TAT (HR 0.98, 95% CI 0.79\u20131.22; P\u2009=\u20090.88). There was also no difference regarding the occurrence of myocardial infarction (MI; HR 1.16, 95% CI 0.92\u20131.46; P\u2009=\u20090.21) or stent thrombosis (HR 1.25, 95% CI 0.69\u20132.26; P\u2009=\u20090.46). Absolute numbers for MI were 131\/4278 (3.1%) with TAT and 182\/5039 (3.6%) with DAT, and for stent thrombosis 32\/4278 (0.75%) and 52\/5039 (1%), respectively. A post hoc power calculation based on the size and event rate of this meta-analysis revealed 80% power to detect a 37% and 100% increase in MI and stent thrombosis, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Dual antithrombotic therapy significantly reduces bleedings compared with TAT and seems to have a similar effect in preventing ischaemic endpoints in AF patients post-PCI or ACS. Future investigations are needed to determine its applicability specifically in patients at high risk of ischaemic outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcvp\/pvz021","type":"journal-article","created":{"date-parts":[[2019,6,7]],"date-time":"2019-06-07T15:11:25Z","timestamp":1559920285000},"page":"226-236","source":"Crossref","is-referenced-by-count":34,"title":["Bleeding and ischaemic outcomes in patients treated with dual or triple antithrombotic therapy: systematic review and meta-analysis"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7714-4446","authenticated-orcid":false,"given":"Paul M","family":"Haller","sequence":"first","affiliation":[{"name":"Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5146-0099","authenticated-orcid":false,"given":"Patrick","family":"Sulzgruber","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastiaan","family":"Geelhoed","sequence":"additional","affiliation":[{"name":"Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Tamargo","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, School of Medicine, Instituto de Investigaci\u00f3n Gregorio Mara\u00f1\u00f3n, CIBERCV, Universidad Complutense, Ciudad Universitaria, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Wassmann","sequence":"additional","affiliation":[{"name":"Cardiology Pasing, Munich, Germany and University of the Saarland, Homburg\/Saar, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate B","family":"Schnabel","sequence":"additional","affiliation":[{"name":"Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[{"name":"Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Huber","sequence":"additional","affiliation":[{"name":"3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria"},{"name":"Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria"},{"name":"Faculty of Medicine, Sigmund Freud University, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Niessner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gremmel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria"},{"name":"Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,6,14]]},"reference":[{"key":"2019091808523414900_pvz021-B1","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","article-title":"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","volume":"37","author":"Kirchhof","year":"2016","journal-title":"Eur Heart 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