RE-DUAL PCI: Anti-Thrombotic Management in Patients with Atrial Fibrillation and PCI

RE-DUAL PCI outcomes have been published by the  New England Journal of Medicine along with their presentation at ESC 2017.

The traditional triple anti-thrombotic scheme with dual antiplatelet therapy  and warfarin for patients with atrial fibrillation undergoing coronary angioplasty seems to have been left behind.

This new study showed that the combination of dabigatran with a P2Y12 inhibitor has less bleeding, without raising thrombotic events compared to the classic triple scheme.

Read also: “Dual Antiplatelet in TAVR: Is Single Better?”

Two daily 110 mg doses combined with clopidogrel or ticagrelor was shown to reduce primary safety end point by 11.5% (major or clinically relevant bleeding). The 15.4% rate with dabigatran vs. 26.9% of the warfarin scheme reached both non-inferiority and superiority.

Increasing dabigatran to two 150 mg doses a day, the results were 20.2% vs. 25.7%, which only reached the non-inferiority criterion.

Together with the WOEST and PIONEER AF-PCI studies, the RE-DUAL PCI is the third study to show that giving up aspirin has a great impact in bleeding reduction, with no increased risk of thrombotic events.

Read also: “Post DES Dual Antiplatelet Therapy Still under Debate”.

This work, carried out in 414 centers in 41 countries, included 2725 patients with non-valvular atrial fibrillation that had recently undergone PCI.

They were divided in 3 groups: warfarin + one P2Y12 inhibitor + aspirin; dabigatran 110 mg twice a day + one P2Y12 inhibitor; dabigatran 150 twice a day + one P2Y12 inhibitor.

The triple scheme group received aspirin for a month after BMS implantation and for 3 months after DES implantation.

Original Title: Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation.

Reference: Cannon CP.

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