{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T14:15:57Z","timestamp":1784816157583,"version":"3.55.0"},"reference-count":27,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2018,5,15]]},"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:p>The coexistence of coronary artery disease and atrial fibrillation (AF) in the same individuals raises great concern about the co-treatment with different antithrombotic agents in the case of percutaneous coronary interventions (PCI). The advent of direct oral anticoagulants (DOACs) revolutionised the therapy of AF; less is known, however, about the safety and efficacy of therapy with DOACs in combination with antiplatelet agents after PCI. We performed a meta-analysis of randomized controlled studies enrolling patients with nonvalvular AF undergoing PCI. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for any bleeding (AB), cardiovascular events (CVE), major bleeding (MB), myocardial infarction (MI), and stent thrombosis (ST) at follow-up: 4849 patients have been included in the analysis. When compared with patients receiving standard triple therapy (vitamin-K antagonists plus double antiplatelet therapy [VKAs plus DAPT]), patients receiving DOACs (rivaroxaban\/dabigatran plus either one or two antiplatelet agents) had a statistically significant lower risk of AB (RR, 0.66; 95% CI, 0.59\u20130.75, p&lt;0.00001), as well as of MB (RR, 0.59; 95% CI, 0.47\u20130.73, p&lt;0.00001). Equivalent efficacy was found about CVE (RR, 1.03; 95% CI, 0.89\u20131.19, p=0.69), MI (RR, 1.09; 95% CI, 0.81\u20131.45, p=0.57), while slight although non-statistically significant increased risk of ST was found (RR, 1.46; 95% CI, 0.86\u20132.48, p=0.16). In conclusion, DOACs are safer than and as effective as warfarin when used in patients with AF undergoing PCI; dual therapy with DOACs is comparable to triple therapy in terms of safety and efficacy.<\/jats:p>","DOI":"10.1136\/openhrt-2018-000785","type":"journal-article","created":{"date-parts":[[2018,7,4]],"date-time":"2018-07-04T02:50:06Z","timestamp":1530672606000},"page":"e000785","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Direct oral anticoagulants versus standard triple therapy in atrial fibrillation and PCI: meta-analysis"],"prefix":"10.1136","volume":"5","clinical-trial-number":[{"clinical-trial-number":"nct02635230","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02866175","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02635230","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02866175","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9610-7408","authenticated-orcid":false,"given":"Natale Daniele","family":"Brunetti","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Tarantino","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"De Gennaro","sequence":"additional","affiliation":[{"name":"Cardiology Department, San Paolo Hospital, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Correale","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Santoro","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy"},{"name":"Department of Cardiology, Asklepios Klinik Sankt Georg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Di Biase","sequence":"additional","affiliation":[{"name":"GVM Care & Research, Santa Maria Hospital, Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,7,3]]},"reference":[{"key":"2025081612084861000_5.2.e000785.1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.006717","article-title":"Concomitant obesity and metabolic syndrome add to the atrial arrhythmogenic phenotype in male hypertensive rats","volume":"6","author":"Hohl","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2025081612084861000_5.2.e000785.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-03062-8"},{"key":"2025081612084861000_5.2.e000785.3","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jjcc.2013.09.010","article-title":"Atrial fibrillation and coronary artery disease: resembling twins?","volume":"63","author":"Akao","year":"2014","journal-title":"J Cardiol"},{"key":"2025081612084861000_5.2.e000785.4","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.advms.2017.06.005","article-title":"Patients with atrial fibrillation and coronary artery disease - 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Edoxaban Treatment Versus Vitamin K Antagonist in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention (ENTRUST-AF-PCI). 2017. https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02866175"},{"key":"2025081612084861000_5.2.e000785.27","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1177\/1076029617706756","article-title":"Safety and efficacy of bridging with low-molecular-weight heparin during temporary interruptions of warfarin: a register-based cohort study","volume":"23","author":"Sj\u00f6gren","year":"2017","journal-title":"Clin Appl Thromb Hemost"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2018-000785","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T19:08:59Z","timestamp":1755371339000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2018-000785"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,7,3]]},"published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1136\/openhrt-2018-000785"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2018-000785","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6]]}}}