Safety and Efficacy Comparison of Ticagrelor versus Other P2Y12 Inhibitors in Combination with Oral Anticoagulants as a Part of DAPT/SAPT in Patients with Concomitant Atrial Fibrillation and Coronary Artery Disease: A Meta-Analysis.

OBJECTIVE

We performed a meta-analysis of randomized controlled trials to assess the safety and efficacy of ticagrelor or other P2Y12 inhibitors in combination with oral anticoagulants as a part of DAPT/SAPT for the patients with atrial fibrillation (AF) and acute coronary disease (ACS) or undergoing percutaneous coronary intervention (PCI).

METHODS

We searched PubMed, Web of Science and ClinicalTrials.gov for randomized controlled trials (published from January 1, 1998, up to June 6, 2023; no language restrictions) comparing safety and efficacy of ticagrelor and DOACs or VKAs combination treatment arm with or without aspirin to other P2Y12 inhibitors treatment strategies. Main endpoints were clinically relevant bleeding as safety outcomes, all-cause mortality, and major adverse cardiovascular events (MACE) as efficacy outcomes.

RESULTS

Of 248 identified studies, 3 were eligible and were included in our analysis (N= 9463 participants). Ticagrelor and DOAC or VKA combination treatment with or without aspirin strategy was associated with an increased rate of bleeding compared with clopidogrel (odds ratio [OR] 1.39, 95% CI 1.15 to 1.67, I2=0%). MACE was similar between ticagrelor versus clopidogrel (OR 1.00, 95% CI 0.54 to 1.86, I2=68.1%) and between ticagrelor versus prasugrel (OR 0.86, 95% CI 0.28 to 2.65, I2=0%).

CONCLUSION

The use of ticagrelor is associated with significantly higher rates of bleeding when compared with clopidogrel in patients with concomitant atrial fibrillation and coronary artery disease.