SYSTEMATIC REVIEW Meta-Analysis of Oral Anticoagulants with Dual versus Single Antiplatelet Therapy in Patients after Percutaneous Coronary Intervention Alexandros Briasoulis 1 • Nikolaos Papageorgiou 2,3 • Efimia Zacharia 3 • Mohan Palla 1 • Mohamad Darwich El Abdallah 1 • Emmanuel Androulakis 3,4 • Dimitris Tousoulis 3 Published online: 9 December 2015 Ó Springer International Publishing Switzerland 2015 Abstract Background The combined use of dual antiplatelet ther- apy with oral anticoagulation (OAC) is required after coronary artery stenting or acute coronary syndromes (ACS). Methods and Results We performed a meta-analysis (Embase and MEDLINE search) of the comparative effects of triple antithrombotic therapy (TT) versus OAC with single antiplatelet therapy (dual therapy [DT]) on all- cause mortality, stroke, cardiovascular death, myocardial infarction (MI), target vessel revascularization, and major bleeding. Three prospective controlled studies and five cohort studies compared TT versus DT. We identified three prospective controlled and five cohort studies with 4564 patients on TT and 1848 on DT with an average follow-up duration of 10.1 months. TT is associated with similar rates of all-cause mortality, stroke, and major bleeding but significantly lower rates of MI compared with DT. Conclusions Triple antithrombotic therapy is associated with similar mortality and bleeding rates but fewer MIs compared with OAC and single antiplatelet therapy. Key Points The combined use of dual antiplatelets with oral anticoagulants is required after coronary artery stenting or acute coronary syndromes. Our analysis suggests that triple antithrombotic therapy is associated with similar mortality and bleeding rates but fewer myocardial infarctions compared with oral anticoagulation and single antiplatelet therapy. 1 Introduction Current guidelines recommend 12 or more months of dual antiplatelet therapy (DAPT) with aspirin and P2Y 12 receptor antagonists after coronary artery stenting with drug-eluting stents (DES) or acute coronary syndrome (ACS) [1]. Of these patients, 10 % have atrial fibrillation, mechanical heart valves, or venous thromboembolic dis- ease and require treatment with oral anticoagulants (OACs) for prevention of thromboembolic events [2]. The combi- nation of aspirin with OAC does not effectively prevent stent thrombosis. Moreover, DAPT is less effective in thromboembolic risk prevention than OAC. Therefore, for patients requiring OAC, triple antithrombotic therapy (TT), A. Briasoulis and N. Papageorgiou contributed equally to this work. Electronic supplementary material The online version of this article (doi:10.1007/s40256-015-0154-z) contains supplementary material, which is available to authorized users. & Alexandros Briasoulis alexbriasoulis@gmail.com 1 Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA 2 Barts Heart Centre, St Bartholomew’s Hospital, London, UK 3 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece 4 John Radcliffe Hospital, University of Oxford, Oxford, UK Am J Cardiovasc Drugs (2016) 16:103–110 DOI 10.1007/s40256-015-0154-z