Comparison of Dual vs. Triple Antithrombotic Therapy in Non-Valvular AF and Acute Coronary Syndrome: A Malaysian Cohort Study

Abstract

Objectives: This study aimed to compare Dual Antithrombotic Therapy (DAT) and Triple Antithrombotic Therapy (TAT) concerning bleeding and thrombosis outcomes in Malaysian patients with non-valvular atrial fibrillation (NVAF) and acute coronary syndrome (ACS), considering demographic characteristics and comorbidities. Methodology: A retrospective observational cohort study was conducted at Hospital Serdang from January 1, 2020, to May 1, 2022. A total of 206 patients were selected via purposive sampling and divided into two groups. The TAT group received warfarin, clopidogrel, and aspirin, while the DAT group received warfarin and clopidogrel over a 1-year follow-up. Multivariate logistic regression analysis was employed. Results: A higher incidence of thromboembolic episodes was observed in the DAT group (24.3% vs. 8.7% in the TAT group; adjusted odds ratio (aOR) 4.53, 95% CI 1.806-11.379, P= 0.001), signifying a 4.5-fold increase in thromboembolic events in DAT compared to TAT. Conversely, more bleeding episodes were observed in the TAT group (25.2% vs. 15.5% in the DAT group; aOR 2.22, 95% CI 0.993-4.970, P= 0.52), although the difference was not statistically significant. Conclusion: The DAT protocol showed significantly more thrombosis episodes than the TAT protocol, while TAT exhibited a non-significant increase in bleeding events compared to DAT at one year follow-up in patients with NVAF and ACS.