About 15% of patients with AF require percutaneous coronary interventions (PCIs) with stent placement to treat obstructive coronary artery disease (CAD). Dual anti-platelet therapy (DAPT) with acetylsalicylic acid (aspirin) and P2Y12 antagonist is recommended after PCI. Patients requiring DAPT also require treatment with oral anticoagulants for AF.

We found 4 RCTs (ENTRUST, AUGUSTUS, PIONEER, REDUAL) using different NOACs. AUGUSTUS trial was excluded since data was not available to be analyzed. Three trials were included for final analysis. Overall, 6355 patients (median age 70 years, 27.6% female, mean CHADS2VASC Score 3.5) were included. Network metanalysis showed that dual therapy group had a lower risk of major bleeding [HR 0.627 (95% CI:0.49-0.79; p=0.005)] and intracranial hemorrhage [HR 0.34 (95% CI:0.18-0.65; p=0.009)] as compared to triple therapy group. There was no  significantly increased risk of ischemic stroke [HR 1.12 (95% CI:0.87-1.43; p=0.262)] or myocardial infarction [HR 1.13 (95% CI 0.79-1.61; p=0.378). However, risk of stent thrombosis was mildly increased for dual therapy group [HR 1.38 (95% CI:1.00-1.9; p=0.049)].

The use of dual therapy (single antiplatelet and NOAC) is associated with a lower risk of major bleeding and intracranial hemorrhage, with no significant difference in ischemic events (stroke and myocardial infarction), when compared to triple therapy. However, the risk of stent thrombosis was higher for the dual therapy group.