Dual Therapy Noninferior to Triple Therapy for A-Fib With PCI

And lower risk of bleeding with dabigatran and P2Y12 inhibitor dual therapy versus triple therapy


MONDAY, Aug. 28, 2017 (HealthDay News) -- For patients with atrial fibrillation who undergo percutaneous coronary intervention (PCI), the risk of bleeding is lower with dual therapy than triple therapy, and dual therapy is noninferior to triple therapy regarding risk of thromboembolic events, according to a study published online Aug. 27 in the New England Journal of Medicine. The research was published to coincide with the European Society of Cardiology Congress 2017, held from Aug. 26 to 30 in Barcelona, Spain.

Christopher P. Cannon, M.D., from Brigham and Women's Hospital in Boston, and colleagues randomized 2,725 patients with atrial fibrillation who had undergone PCI to triple therapy with warfarin plus a P2Y12 inhibitor and aspirin (triple-therapy group) or dual therapy with dabigatran (110 or 150 mg twice daily) plus a P2Y12 inhibitor and no aspirin (dual-therapy group).

The researchers found that the incidence of the primary end point of a major or clinically relevant nonmajor bleeding event during follow-up (mean, 14 months) was 15.4 and 26.9 percent in the 110-mg dual-therapy and triple-therapy groups, respectively (hazard ratio, 0.52; 95 percent confidence interval, 0.42 to 0.63; P < 0.001 for noninferiority; P < 0.001 for superiority). The incidence was 20.2 and 25.7 percent in the 150-mg dual-therapy group and the corresponding triple-therapy group, respectively (hazard ratio, 0.72; 95 percent confidence interval, 0.58 to 0.88; P < 0.001 for noninferiority).

"Dual therapy was noninferior to triple therapy with respect to the risk of thromboembolic events," the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Boehringer Ingelheim, which funded the study.

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