Objective: To evaluate the impact of various anticoagulation antiplatelet
therapy strategies on the prognosis of patients with
coronary heart disease combining with
atrial fibrillation. Methods: Present meta analysis was performed according to search results on English EMBASE database by computer retrieval, Pubmed, the Cochrane Central Register of Controlled Trials, Medline, Chinese CBM database, CNKI database, Wan Fang database, China science and technology papers online electronic databases, manual retrieval for important international conference proceedings up to April 30 2016. Trials published in English and Chinese language, which met the Cochrane system evaluation requirements were included and the inclusion and exclusion criteria were made based on Cochrane system evaluation requirements. The end point is the incident of
major adverse cardiac events (
MACE),
ischemic stroke and major
bleeding events. The patients were randomly assigned into triple antithrombotic
therapy (aspirin+ clopidogrel+
warfarin) group and dual antiplatelet
therapy (aspirin+
clopidogrel) group.The collected full-text literatures underwent further quality assessment of the risks of bias using RevMan 5.3 software. Impact of various antithrombotic therapeutic strategies on the outcome of
coronary heart disease patients combining with
atrial fibrillation were evaluated. Results: In this meta analysis, 12 randomized controlled trials with 11 353 patients were included. Among these patients, 3 486 patients received triple antithrombotic
therapy and 7 867 patients received
dual anti-platelet therapy. There was no significant difference in incidence rate of
MACE (OR=0.93, 95%CI 0.74-1.18, P>0.05) and the incidence rate of
ischemic stroke (OR=0.88, 95%CI 0.70-1.10, P=0.27) between the two patients groups. However, the incidence rate of major
bleeding events in triple antithrombotic therapy group was twice higher than that in
dual anti-platelet therapy (OR=1.94, 95%CI 1.33-2.82, P=0.000 6). Conclusion: Compared with
dual anti-platelet therapy strategy,
coronary heart disease patients combining with
atrial fibrillation who were treated by triple antithrombotic
therapy strategy have the similar outcome on risk of
ischemic stroke, but higher risk of major
bleeding events.