Choosing an antithrombotic regime in patients with acute coronary syndrome (ACS) and a concomitant indication for anticoagulation is a challenge commonly encountered by clinicians. Our aim in this article is to evaluate the safety and efficacy of triple antithrombotic therapy (TT, anticoagulant plus dual antiplatelet) versus dual antithrombotic therapy (DT, anticoagulant plus single antiplatelet) in patients with acute coronary syndrome. We included all randomized trials comparing the outcomes of single versus dual antiplatelet therapy in patients with acute coronary syndrome on anticoagulants. The primary outcome was major adverse cardiac events (MACE). Other outcomes studied were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, stent thrombosis and major bleeding. The Mantel-Haenszel risk ratio (RR) random effects model was used to summarize data. Six studies, with a total of 11,437 patients, met our selection criteria. With a follow-up duration of 9-14 months, there was no significant difference between DT and TT in terms of MACE (RR 0.96, 95% confidence interval [CI] 0.79-1.17), all-cause mortality (RR 1.00, 95% CI 0.77-1.29), cardiovascular mortality (RR1.03, 95% CI 0.79-1.34), MI (RR 1.14, 95% CI 0.90-1.45), stroke (RR 0.83, 95% CI 0.56-1.23) and stent thrombosis (RR 1.32 95% CI 0.87-2.01). Compared with TT, DT was associated with significant reductions in major bleeding 4.1% vs 6.5% (RR 0.61, 95% CI 0.45-0.81, NNT=42), clinically significant bleeding 10.5% vs 16.4% (RR 0.62, 95% CI 0.48-0.80) and intracranial hemorrhage 0.4% vs 0.8% (RR 0.43, 95% CI 0.24-0.77). In patients on anticoagulant therapy, the strategy of single antiplatelet therapy (DT) confers a benefit of less major bleeding with no difference in MACE, all-cause mortality, cardiovascular mortality, MI, stroke and ST.

中文翻译：

---

急性冠状动脉综合征和抗凝适应症患者的双重治疗与三重治疗 - 荟萃分析和试验序贯分析的系统评价。

为急性冠脉综合征（ACS）患者选择抗血栓治疗方案并伴有抗凝治疗是临床医生经常遇到的挑战。我们本文的目的是评估三联抗血栓治疗（TT，抗凝剂加双重抗血小板）与双重抗血栓治疗（DT，抗凝剂加单抗血小板）对急性冠脉综合征患者的安全性和有效性。我们纳入了所有比较单抗血小板治疗与双联抗血小板治疗对急性冠脉综合征患者抗凝药物治疗结果的随机试验。主要结局是主要不良心脏事件（MACE）。研究的其他结果包括全因死亡率、心血管死亡率、心肌梗塞（MI）、中风、支架内血栓形成和大出血。Mantel-Haenszel 风险比 (RR) 随机效应模型用于总结数据。六项研究，总共 11,437 名患者，符合我们的选择标准。随访时间为 9-14 个月，DT 和 TT 在 MACE（RR 0.96，95% 置信区间 [CI] 0.79-1.17）、全因死亡率（RR 1.00，95）方面没有显着差异。 % CI 0.77-1.29)、心血管死亡率（RR 1.03，95% CI 0.79-1.34）、MI（RR 1.14，95% CI 0.90-1.45）、卒中（RR 0.83，95% CI 0.56-1.23）和支架内血栓形成（RR 1.32 95% CI 0.87-2.01）。与 TT 相比，DT 显着减少大出血 4.1% vs 6.5%（RR 0.61，95% CI 0.45-0.81，NNT=42），临床显着出血减少 10.5% vs 16.4%（RR 0.62，95% CI 0.48） -0.80）和颅内出血 0.4% vs 0.8%（RR 0.43，95% CI 0.24-0.77）。对于接受抗凝治疗的患者，单一抗血小板治疗 (DT) 策略具有减少大出血的益处，且 MACE、全因死亡率、心血管死亡率、MI、卒中和 ST 方面没有差异。