Systematic review/meta-analysisRisk of Bleeding on Triple Antithrombotic Therapy After Percutaneous Coronary Intervention/Stenting: A Systematic Review and Meta-analysis
Section snippets
Methods
This systematic review was performed using a predetermined protocol and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology Statement Guidelines (MOOSE).15, 16
Literature search
The search of online databases identified 4100 unique articles, the abstracts of which were reviewed to determine their suitability for full-text review, with 99% agreement among reviewers (Fig. 1). Full-text reviews were also done of the 53/4100 abstracts for which there was disagreement and of 8 articles identified from review of bibliographies. Of the 186 articles that underwent full-text review there was 99% agreement among reviewers regarding inclusion/exclusion following data extraction.
Discussion
There is uncertainty about the optimal combination and duration of antithrombotic therapies for patients who are undergoing PCI-S and who also have indications for OAC. This uncertainty is in part attributable to considerable variability in the reported rates of bleeding caused and cardiovascular events avoided.39 While initial small series raised concerns over the safety of TT, larger contemporary studies have documented lower major bleeding rates.
When randomized controlled trials are not
Disclosures
Dr Cairns has in the last 3 years, chaired or been a member of the Data and Safety Monitoring Board of the following industry-sponsored trials: PALLAS [Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy] (Sanofi-Aventis), ACTIVE (Sanofi-Aventis), AVERROES [Apixaban Versus Acetylsalicylic Acid to Prevent Strokes in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment] (Bristol-Myers Squibb), and SHIELD-2 [Efficacy
Acknowledgements
The authors thank Dean Giustini, MLS, MEd, of the Biomedical Branch Library, University of British Columbia, for his invaluable guidance.
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See editorial by Healey, pages 136-138 of this issue.
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