Background The safety and effectiveness of dual therapy (direct oral anticoagulant [DOAC] plus P2Y12 inhibitor) versus triple therapy (vitamin K antagonist plus aspirin and P2Y12 inhibitor) in patients with nonvalvular atrial fibrillation (AF) after percutaneous coronary intervention (PCI) is unclear. Purpose To examine the effects of dual versus triple therapy on bleeding and ischemic outcomes in adults with AF after PCI. Data Sources Searches of PubMed, EMBASE, and the Cochrane Library (inception to 31 December 2019) and ClinicalTrials.gov (7 January 2020) without language restrictions; journal Web sites; and reference lists. Study Selection Randomized controlled trials that compared the effects of dual versus triple therapy on bleeding, mortality, and ischemic events in adults with AF after PCI. Data Extraction Two independent investigators abstracted data, assessed the quality of evidence, and rated the certainty of evidence. Data Synthesis Four trials encompassing 7953 patients were selected. At the median follow-up of 1 year, high-certainty evidence showed that dual therapy was associated with reduced risk for major bleeding compared with triple therapy (risk difference [RD], -0.013 [95% CI, -0.025 to -0.002]). Low-certainty evidence showed inconclusive effects of dual versus triple therapy on risks for all-cause mortality (RD, 0.004 [CI, -0.010 to 0.017]), cardiovascular mortality (RD, 0.001 [CI, -0.011 to 0.013]), myocardial infarction (RD, 0.003 [CI, -0.010 to 0.017]), stent thrombosis (RD, 0.003 [CI, -0.005 to 0.010]), and stroke (RD, -0.003 [CI, -0.010 to 0.005]). The upper bounds of the CIs for these effects were compatible with possible increased risks with dual therapy. Limitation Heterogeneity of study designs, dosages of DOACs, and types of P2Y12 inhibitors. Conclusion In adults with AF after PCI, dual therapy reduces risk for bleeding compared with triple therapy, whereas its effects on risks for death and ischemic end points are still unclear. Primary Funding Source None.

中文翻译：

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经皮冠状动脉介入治疗后房颤的双重对三联疗法：系统评价和荟萃分析。

背景技术经皮冠状动脉介入治疗（PCI）后非瓣膜性心房颤动（AF）患者中，双重疗法（直接口服抗凝药[DOAC]加P2Y12抑制剂）与三次疗法（维生素K拮抗剂加阿司匹林和P2Y12抑制剂）的安全性和有效性尚不清楚。目的探讨双重治疗与三次治疗对成年人PCI术后AF的出血和缺血结局的影响。不受语言限制的PubMed，EMBASE和Cochrane图书馆（成立至2019年12月31日）和ClinicalTrials.gov（2020年1月7日）的数据源搜索; 期刊网站；和参考清单。研究选择随机对照试验比较了双重和三次治疗对PCI后成人房颤出血，死亡率和缺血事件的影响。数据提取两名独立的调查人员提取数据，评估证据的质量并评估证据的确定性。数据综合选择了涵盖7953名患者的四项试验。在1年的中位随访中，高确定性证据表明，与三联疗法相比，双联疗法与降低大出血风险相关（风险差异[RD]，-0.013 [95％CI，-0.025至-0.002] ）。低确定性的证据显示双重或三联疗法对全因死亡率（RD，0.004 [CI，-0.010至0.017]），心血管疾病的死亡率（RD，0.001 [CI，-0.011至0.013]）的不确定性影响梗死（RD，0.003 [CI，-0.010至0.005]），支架血栓形成（RD，0.003 [CI，-0.005至0.010]）和中风（RD，-0.003 [CI，-0.010至0.005]）。这些效应的CI上限与双重疗法可能增加的风险相吻合。研究设计的局限性，DOAC的剂量和P2Y12抑制剂的类型。结论在接受PCI治疗的房颤患者中，双重疗法与三次疗法相比可降低出血风险，但对死亡风险和缺血终点的影响尚不清楚。主要资金来源无。