{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:48:25Z","timestamp":1760237305482,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,4,8]],"date-time":"2020-04-08T00:00:00Z","timestamp":1586304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Up to 10% of patients with atrial fibrillation (AF) undergo percutaneous coronary intervention (PCI). A systematic review and network meta-analysis were conducted by searching PubMed, Embase, and the Cochrane database of systematic reviews for randomized control trials that studied the safety and efficacy of different antithrombotic strategies in these patients. Six studies, including 12,158 patients were included. Compared to that in the triple antithrombotic therapy group (vitamin K antagonist (VKA) plus P2Y12 inhibitor and aspirin), thrombolysis in myocardial infarction (TIMI) major bleeding was significantly reduced in the dual antithrombotic therapy (non-vitamin K oral anticoagulants (NOACs) plus P2Y12 inhibitor) group by 47% (Odds ratio (OR), 0.53; 95% credible interval [CrI], 0.35\u20130.78; I2 = 0%). Besides, NOAC plus a P2Y12 inhibitor was associated with less intracranial hemorrhage compared to VKA plus single antiplatelet therapy (OR: 0.20, 95% CrI: 0.05\u20130.77). There was no significant difference in the trial-defined major adverse cardiac events or the individual outcomes of all-cause mortality, cardiovascular death, myocardial infarction, stroke or stent thrombosis among all antithrombotic strategies. In conclusion, antithrombotic strategy of NOACs plus P2Y12 inhibitor is safer than, and as effective as, the strategies including aspirin when used in AF patients undergoing PCI.<\/jats:p>","DOI":"10.3390\/jcm9041062","type":"journal-article","created":{"date-parts":[[2020,4,9]],"date-time":"2020-04-09T03:40:19Z","timestamp":1586403619000},"page":"1062","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Antithrombotic Strategies in Patients with Atrial Fibrillation Following Percutaneous Coronary Intervention: A Systemic Review and Network Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1893-6360","authenticated-orcid":false,"given":"Su-Kiat","family":"Chua","sequence":"first","affiliation":[{"name":"School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan"},{"name":"Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"},{"name":"Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lung-Ching","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"},{"name":"Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kou-Gi","family":"Shyu","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"},{"name":"Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun-Jack","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"},{"name":"Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huei-Fong","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"},{"name":"Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiung-Zuan","family":"Chiu","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"},{"name":"Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiu-Mei","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan"},{"name":"Department of Emergency Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kralev, S., Schneider, K., Lang, S., Suselbeck, T., and Borggrefe, M. (2011). Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0024964"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jacc.2019.01.011","article-title":"2019 AHA\/ACC\/HRS Focused Update of the 2014 AHA\/ACC\/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society","volume":"74","author":"January","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1093\/eurheartj\/ehy136","article-title":"The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation","volume":"39","author":"Steffel","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3759","DOI":"10.1093\/eurheartj\/ehy658","article-title":"Ten Commandments\u2019 for the 2018 ESC\/EACTS Guidelines on Myocardial Revascularization","volume":"39","author":"Neumann","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1161\/CIR.0000000000000336","article-title":"2015 ACC\/AHA\/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF\/AHA\/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF\/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions","volume":"133","author":"Levine","year":"2016","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1161\/CIRCULATIONAHA.109.924944","article-title":"Triple antithrombotic therapy in patients with atrial fibrillation and coronary artery stents","volume":"121","author":"Paikin","year":"2010","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jacc.2009.03.044","article-title":"Combining antiplatelet and anticoagulant therapies","volume":"54","author":"Holmes","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1016\/j.jacc.2015.02.050","article-title":"Duration of Triple Therapy in Patients Requiring Oral Anticoagulation After Drug-Eluting Stent Implantation: The ISAR-TRIPLE Trial","volume":"65","author":"Fiedler","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/S0140-6736(12)62177-1","article-title":"Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: An open-label, randomised, controlled trial","volume":"381","author":"Dewilde","year":"2013","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1056\/NEJMoa1611594","article-title":"Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI","volume":"375","author":"Gibson","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1056\/NEJMoa1708454","article-title":"Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation","volume":"377","author":"Cannon","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1056\/NEJMoa1817083","article-title":"Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation","volume":"380","author":"Lopes","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lopes, R.D., Hong, H., Harskamp, R.E., Bhatt, D.L., Mehran, R., Cannon, C.P., Granger, C.B., Verheugt, F.W.A., Li, J., and Ten Berg, J.M. (2019). Safety and Efficacy of Antithrombotic Strategies in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Network Meta-analysis of Randomized Controlled Trials. JAMA Cardiol.","DOI":"10.1001\/jamacardio.2019.1880"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1726a","DOI":"10.1093\/eurheartj\/ehy162","article-title":"Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: A systematic review and meta-analysis of randomized clinical trials","volume":"39","author":"Golwala","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e000785","DOI":"10.1136\/openhrt-2018-000785","article-title":"Direct oral anticoagulants versus standard triple therapy in atrial fibrillation and PCI: Meta-analysis","volume":"5","author":"Brunetti","year":"2018","journal-title":"Open Heart"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Vranckx, P., Valgimigli, M., Eckardt, L., Tijssen, J., Lewalter, T., Gargiulo, G., Batushkin, V., Campo, G., Lysak, Z., and Vakaliuk, I. (2019). Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): A randomised, open-label, phase 3b trial. Lancet.","DOI":"10.1016\/S0140-6736(19)31872-0"},{"key":"ref_17","first-page":"e123","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement","volume":"3","author":"Moher","year":"2009","journal-title":"Open Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e8015","DOI":"10.1097\/MD.0000000000008015","article-title":"The safety and efficacy of oral anticoagulants with dual versus single antiplatelet therapy in patients after percutaneous coronary intervention: A meta-analysis","volume":"96","author":"Chen","year":"2017","journal-title":"Medicine (Baltim.)"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"81154","DOI":"10.18632\/oncotarget.20870","article-title":"Efficacy and safety of triple versus dual antithrombotic therapy in atrial fibrillation and ischemic heart disease: A systematic review and meta-analysis","volume":"8","author":"Zhu","year":"2017","journal-title":"Oncotarget"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Gong, X., Tang, S., Li, J., Zhang, X., Tian, X., and Ma, S. (2017). Antithrombotic therapy strategies for atrial fibrillation patients undergoing percutaneous coronary intervention: A systematic review and network meta-analysis. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0186449"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.amjmed.2017.03.057","article-title":"Safety and Efficacy of Dual Versus Triple Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention","volume":"130","author":"Agarwal","year":"2017","journal-title":"Am. J. Med."},{"key":"ref_23","first-page":"725","article-title":"Dual versus single antiplatelet therapy for patients with long-term oral anticoagulation undergoing coronary intervention: A systematic review and meta-analysis","volume":"14","author":"Yu","year":"2017","journal-title":"J. Geriatr. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.amjcard.2017.12.014","article-title":"Meta-Analysis Comparing the Safety and Efficacy of Dual Versus Triple Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention","volume":"121","author":"Cavallari","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Liu, L., Huang, J., Zhang, X., and Tang, X. (2018). Efficacy and safety of triple therapy versus dual antiplatelet therapy in patients with atrial fibrillation undergoing coronary stenting: A meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0199232"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.3389\/fphar.2018.01322","article-title":"Antithrombotic Regimens in Patients With Percutaneous Coronary Intervention Whom an Anticoagulant Is Indicated: A Systematic Review and Network Meta-Analysis","volume":"9","author":"Bunmark","year":"2018","journal-title":"Front. Pharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1002\/clc.22855","article-title":"Safety and efficacy of second-generation drug-eluting stents compared with bare-metal stents: An updated meta-analysis and regression of 9 randomized clinical trials","volume":"41","author":"Mahmoud","year":"2018","journal-title":"Clin. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1016\/S0140-6736(96)09457-3","article-title":"A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee","volume":"348","author":"Committee","year":"1996","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3757","DOI":"10.1093\/eurheartj\/ehz732","article-title":"Safety and efficacy outcomes of double vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: A systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulant-based randomized clinical trials","volume":"40","author":"Gargiulo","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials: A consensus report from the Bleeding Academic Research Consortium","volume":"123","author":"Mehran","year":"2011","journal-title":"Circulation"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/1062\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:16:42Z","timestamp":1760174202000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/1062"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,8]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,4]]}},"alternative-id":["jcm9041062"],"URL":"https:\/\/doi.org\/10.3390\/jcm9041062","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2020,4,8]]}}}