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The optimal antithrombotic regimen remains controversial in patients taking oral anticoagulation ( OAC ) undergoing coronary stenting. This study sought to compare efficacy and safety outcomes of triple therapy ( OAC , aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or  OAC ) in these patients. We hypothesize  OAC  plus clopidogrel could be the optimal regimen for patients with indications for  OAC  receiving stent implantation. Medline, the Cochrane Library, and other Internet sources were searched for clinical trials comparing the efficacy and safety of triple vs dual therapy for patients taking  OAC  after coronary stenting. Sixteen eligible trials including 9185 patients were identified. The risks of major adverse cardiac events (odds ratio [ OR ]: 1.06, 95% confidence interval [ CI ]: 0.82‐1.39,  P  = 0.65), all‐cause mortality ( OR : 0.98, 95%  CI : 0.76‐1.27,  P  = 0.89), myocardial infarction ( OR : 1.01, 95%  CI : 0.77‐1.31,  P  = 0.97), and stent thrombosis ( OR : 0.91, 95%  CI : 0.49‐1.69,  P  = 0.75) were similar between triple and dual therapy. Compared with dual therapy, triple therapy was associated with a reduced risk of ischemic stroke ( OR : 0.57, 95%  CI : 0.35‐0.94,  P  = 0.03) but with higher major bleeding ( OR : 1.52, 95%  CI : 1.11‐2.10,  P  = 0.01) and minor bleeding ( OR : 1.59, 95%  CI : 1.05‐2.42,  P  = 0.03). Subgroup analysis indicated there were similar ischemic stroke and major bleeding outcomes between triple therapy and therapy with  OAC  plus clopidogrel. Treatment with  OAC  and clopidogrel was associated with similar efficacy and safety outcomes compared with triple therapy. Triple therapy could be replaced by  OAC  plus clopidogrel without any concern about additional risk of thrombotic events.

Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta‐analysis of 16 Clinical Trials and 9185 Patients