Dual antithrombotic therapy with dabigatran in patients with atrial fibrillation after percutaneous coronary intervention for ST-segment elevation myocardial infarction: a post hoc analysis of the randomised RE-DUAL PCI trial.

Abstract

BACKGROUND:

Little is known about the optimal antithrombotic therapy in patients with atrial fibrillation undergoing PCI for ST-elevation myocardial infarction (STEMI).

AIMS:

The aim of this study was to investigate the safety and efficacy of dabigatran dual therapy (110 or 150 mg twice daily, plus clopidogrel or ticagrelor) versus warfarin triple therapy in patients with atrial fibrillation and STEMI.

METHODS:

In the RE-DUAL PCI trial, 305 patients with STEMI were randomised to dabigatran 110 mg (n=113 versus 106 warfarin) or 150 mg (n=86 versus 84 warfarin). The primary endpoint was the time to first major/clinically relevant non-major bleeding event (MBE/CRNMBE). The thrombotic endpoint was a composite of death, thromboembolic events, or unplanned revascularisation.

RESULTS:

In STEMI patients, dabigatran 110 mg (HR 0.39, 95% CI: 0.20-0.74) and 150 mg (0.43, 0.21-0.89) dual therapy reduced the risk of MBE/CRNMBE versus warfarin triple therapy (p for interaction vs all other patients=0.31 and 0.16). The risk of thrombotic events for dabigatran 110 mg (HR 1.61, 95% CI: 0.85-3.08) and 150 mg (0.56, 0.20-1.51) had p interactions of 0.20 and 0.33, respectively. For net clinical benefit, the HRs were 0.74 (95% CI: 0.46-1.17) and 0.49 (0.27-0.91) for dabigatran 110 and 150 mg (p for interaction=0.80 and 0.12), respectively.

CONCLUSIONS:

After PCI for STEMI, patients on dabigatran dual therapy had lower risks of bleeding events versus warfarin triple therapy with similar risks of thromboembolic events, supporting dabigatran dual therapy even in patients with high thrombotic risk.

• Authors: Uwe Zeymer, Orly Leiva, Stefan H Hohnloser, Philippe Gabriel Steg, Jonas Oldgren, Georg Nickenig, Robert Gabor Kiss, Zeki Ongen, Jose Navarro Estrada, Ton Oude Ophuis, Gregory Y H Lip, Matias Nordaby, Corinna Miede, Jurrien M Ten Berg, Deepak L Bhatt, Christopher P Cannon
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 17 Issue 6 Pg. 474-480 (Aug 27 2021) ISSN: 1969-6213 [Electronic] France
• PMID: 33164896 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Anticoagulants
• Fibrinolytic Agents
• Platelet Aggregation Inhibitors
• Dabigatran
• Aspirin

Topics

• Anticoagulants (adverse effects)
• Aspirin (therapeutic use)
• Atrial Fibrillation (complications, drug therapy)
• Coronary Artery Disease (drug therapy)
• Dabigatran (adverse effects)
• Drug Therapy, Combination
• Fibrinolytic Agents (therapeutic use)
• Humans
• Percutaneous Coronary Intervention (adverse effects)
• Platelet Aggregation Inhibitors (adverse effects)
• ST Elevation Myocardial Infarction (drug therapy)