Identifying Optimal Triple Antithrombotic Treatment Length in Atrial Fibrillation

Researchers explored the optimal duration of triple antithrombotic therapy (TAT) in patients who have atrial fibrillation (AF) or acute coronary syndrome (ACS) or are undergoing post-percutaneous coronary intervention (PCI). Their network meta-analysis, published in the International Journal of Cardiology, posited that “long-term TAT may be reasonable for patients at a high risk for stent thrombosis, but short-term TAT is associated with fewer bleeding complications, and there are no significant differences in most ischemic events across treatment durations.

The study’s lead author, Wei Wang, and contributing researchers reviewed randomized clinical trials which contained data from a total of 12,329 patients. The authors compared ischemic and bleeding events for four different TAT durations to determine the optimal length for AF, ACS, or post-PCI care.

In their analysis, the authors observed that “short-term TAT is advantageous to varying degrees for reducing bleeding events.” However, they noted that “long-term TAT has a lower stent thrombosis risk than short-term TAT.” In general, the analysis suggested that the four durations have “comparable” results in terms of major adverse cardiovascular events (MACE), stroke, all-cause death, and myocardial infarction events, and the authors reported that “based on Surface Under the Cumulative Ranking (SUCRA) values, no treatment duration has an absolute advantage for reducing these ischemic events.”

Investigators concluded that, “overall, our results indicate that short-term TAT should be the default strategy unless there is a high risk of stent thrombosis that warrants appropriate prolongation of TAT duration.”