COMPARISON OF DUAL VERSUS TRIPLE ANTITHROMBOTIC THERAPY IN ATRIAL FIBRILLATION WITH CORONARY ARTERY DISEASE: A RETROSPECTIVE STUDY

Abstract

Background: Patients with atrial fibrillation (AF) and coronary artery disease (CAD) often require combined antithrombotic therapy, but the optimal balance between prevention of thromboembolic and ischemic events and reduction of bleeding risk remains uncertain. Objective: This study compared clinical outcomes associated with dual versus triple antithrombotic therapy in this high-risk population. Methods: This retrospective comparative cohort study was conducted at Army Cardiac Hospital Lahore from January 06, 2026 to August 05, 2026,  included 238 patients with AF and CAD, of whom 118 received dual antithrombotic therapy and 120 received triple antithrombotic therapy. Clinical outcomes including thromboembolic events, myocardial infarction, stent thrombosis, major bleeding, clinically relevant non-major bleeding, and mortality were evaluated and compared between groups. Results: Thromboembolic events were observed in 10.2% of patients receiving dual therapy and 8.3% receiving triple therapy (p=0.62), while rates of myocardial infarction, stent thrombosis, and major adverse cardiovascular events were also comparable between groups. Major bleeding occurred significantly less frequently in the dual therapy group compared with the triple therapy group (7.6% vs 17.5%, p=0.03). Clinically relevant non-major bleeding was also lower with dual therapy (14.4% vs 25.0%, p=0.04). Multivariable analysis identified triple therapy and elevated HAS-BLED score as independent predictors of major bleeding. Conclusion: Dual antithrombotic therapy demonstrated comparable efficacy to triple therapy for prevention of thromboembolic and ischemic events while significantly reducing bleeding complications.