title: Short- and long-term efficacy and safety of triple vs. dual antithrombotic therapy in patients with drug-eluting stent implantation and an indication for oral anticoagulation: a meta-analysis.
abstract: BACKGROUND
  The optimal antithrombotic regimen after coronary stenting in patients taking oral anticoagulants (OACs) is still unclear. Therefore, this meta-analysis focused on the short- and long-term efficacy and safety of triple therapy (TT: OAC, aspirin, and thienopyridine) and dual therapy (DT: OAC plus single antiplatelet drug or aspirin plus thienopyridine).
  
  
  METHODS
  We searched PubMed, Embase, the Cochrane Library, Wangfang database, and Google Scholar up to December 1, 2015 (January 1, 2000 - December 2015), from randomized and nonrandomized studies comparing TT and DT in patients with OACs undergoing drug-eluting stent (DES) implantation. Major adverse cardiac and cerebrovascular events (MACCE) were the main outcome. Safety outcome was major bleeding (MB).
  
  
  RESULTS
  Of 964 publications identified, 1 randomized study and 27 nonrandomized studies of 31,346 patients were included. Overall, TT and OAC plus clopidogrel were associated with a lower risk of MACCE, stroke, MI, and allcause mortality compared with dual antiplatelet therapy or OAC plus aspirin. Additionally, short-term use of triple antithrombotic regimen with OAC, aspirin, and clopidogrel is associated with equivalent risk of major bleeding and decreased rate of MACCE. Long-term use of OAC plus clopidogrel after TT was associated with equal or better benefit and safety outcomes.
  
  
  CONCLUSIONS
  For patients on OAC after coronary stenting, triple therapy (OAC, aspirin, clopidogrel) should be considered in the short term, followed by more long-term therapy with OAC plus clopidogrel. More randomized studies are needed to confirm these findings.
authors.forename: Yong
authors.initials: Y
authors.lastname: Cao
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Tian
authors.forename: Ran
authors.initials: R
authors.lastname: Zhang
authors.forename: Jia-Qi
authors.initials: JQ
authors.lastname: Zhao
authors.forename: Meng
authors.initials: M
authors.lastname: Zhang
authors.forename: Yun-Tao
authors.initials: YT
authors.lastname: Cheng
authors.forename: Chuan-Fang
authors.initials: CF
authors.lastname: Li
authors.forename: Gen-Li
authors.initials: GL
authors.lastname: Liu
authors.forename: Yi
authors.initials: Y
authors.lastname: An
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents