title: Safety and efficacy of triple antithrombotic therapy after percutaneous coronary intervention in patients needing long-term anticoagulation.
abstract: BACKGROUND
  Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) is currently undefined in patients requiring long-term anticoagulation. Previous studies comparing triple therapy (TT) of warfarin, aspirin and clopidogrel with standard dual therapy (DT) of aspirin and clopidogrel have yielded conflicting results. Meta-analysis of these studies was performed to evaluate safety and efficacy of TT.
  
  
  METHODS
  A total of 1482 patients from 6 studies were analyzed using the Mantel-Haenszel random effect model to extract incidence of major bleeding. The secondary end point assessed by three of these studies was major adverse cardiac events (MACEs: cardiovascular death, myocardial infarction and thromboembolic complications). The incidence of MACEs was computed using the Mantel-Haenszel fixed effect model. Combined relative risks (RRs) across all of the studies and the 95% confidence intervals (CIs) were determined. A two-sided alpha error <0.05 was considered statistically significant.
  
  
  RESULTS
  Baseline characteristics were similar in both groups. Compared with patients receiving DT, the risk of major bleeding was significantly higher in the TT group (RR: 2.74, CI: 1.08-6.98; p=0.034). However, risk of MACE was significantly lower in the TT group (RR: 0.72, CI: 0.56-0.98; p=0.014).
  
  
  CONCLUSIONS
  In patients requiring long-term anticoagulation after PCI, TT may be superior to DT in reducing the incidence of MACEs, however risk of major bleeding complications is increased significantly.
authors.affiliation: Division of Cardiology, Mount Sinai Hospital, 1500 South California Avenue, Chicago, IL 60608, USA. drparamsingh@gmail.com
authors.forename: Param Puneet
authors.initials: PP
authors.lastname: Singh
authors.forename: Mukesh
authors.initials: M
authors.lastname: Singh
authors.forename: Updesh
authors.initials: U
authors.lastname: Bedi
authors.forename: Janos
authors.initials: J
authors.lastname: Molnar
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D000925:Anticoagulants / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced* / Q000401:mortality; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin