{"id":"b9ec4b5439fb","type":"article","url":"https://hartvaat.nl/2019/12/07/dubbele-versus-triple-antitrombotische-therapie-bij-af-na-pci-veiligheid-en-werk/","title":"Dubbele versus triple antitrombotische therapie bij AF na PCI: veiligheid en werkzaamheid","title_en":"Safety and efficacy outcomes of double vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulant-based randomized clinical trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["dubbele-trombocytenremming"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz732","source_url":"https://doi.org/10.1093/eurheartj/ehz732","authors":["Giuseppe Gargiulo","Andreas Goette","Jan Tijssen","Lars Eckardt","Thorsten Lewalter","Pascal Vranckx","Marco Valgimigli"],"significance":7,"published":"2019-12-07","source_date":"2019-12-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This comprehensive analysis of dual versus triple antithrombotic therapy in AF patients after PCI synthesized evidence from multiple trials, confirming the safety advantage of dual therapy while maintaining similar ischemic protection.","created":"2026-07-03T10:28:19Z","updated":"2026-07-03T13:27:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide analyse van veiligheid en werkzaamheid van dubbele versus triple antitrombotische therapie bij AF na PCI. Synthese van alle beschikbare trials.","abstract_original":"AIMS: To investigate the safety and efficacy of double vs. triple antithrombotic therapy (DAT vs. TAT) in patients with atrial fibrillation (AF) and acute coronary syndrome or who underwent percutaneous coronary intervention (PCI). METHODS AND RESULTS: A systematic review and meta-analysis was performed using PubMed to search for non-vitamin K antagonist oral anticoagulant (NOAC)-based randomized clinical trials comparing DAT vs. TAT in AF patients undergoing PCI. Four trials encompassing 10 234 patients (DAT = 5496 vs. TAT = 4738) were included. The primary safety endpoint (ISTH major or clinically relevant non-major bleeding) was significantly lower with DAT compared with TAT [risk ratio (RR) 0.66, 95% confidence interval (CI) 0.56-0.78; P < 0.0001; I2 = 69%], which was consistent across all available bleeding definitions. This benefit was counterbalanced by a significant increase of stent thrombosis (RR 1.59, 95% CI 1.01-2.50; P = 0.04; I2 = 0%) and a trend towards higher risk of myocardial infarction with DAT. There were no significant differences in all-cause and cardiovascular death, stroke and major adverse cardiovascular events. The comparison of NOAC-based DAT vs. vitamin K antagonist (VKA)-TAT yielded consistent results and a significant reduction of intracranial haemorrhage (RR 0.33, 95% CI 0.17-0.65; P = 0.001; I2 = 0%). CONCLUSION: Double antithrombotic therapy, particularly if consisting of a NOAC instead of VKA and a P2Y12 inhibitor, is associated with a reduction of bleeding, including major and intracranial haemorrhages. This benefit is however counterbalanced by a higher risk of cardiac-mainly stent-related-but not cerebrovascular ischaemic occurrences."}