Clinical Outcomes With Postprocedural Anticoagulation Versus No Anticoagulation in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: A Meta-Analysis

Postprocedural anticoagulation (PPAC) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) can mitigate thrombotic events. However, current clinical guidelines do not recommend PPAC after PCI considering the scarce evidence supporting its use. A comprehensive literature search of electronic databases was conducted to identify studies comparing PPAC to no anticoagulation (AC) after PCI for AMI. Using the inverse-variance random-effects model, we pooled risk ratios (RRs) with 95% confidence intervals (CIs), with P < 0.05 considered statistically significant. Seven studies with a total of 47,981 patients (32,010: PPAC and 15,971: no AC) were included in the final analysis. PPAC administration demonstrated no significant difference in 30-day all-cause mortality [RR, 0.73 (95% CI, 0.47-1.16); P = 0.19], 30-day cardiovascular mortality [RR, 0.76 (95% CI, 0.45-1.30); P = 0.32], 30-day myocardial infarction [RR, 0.68 (95% CI, 0.41-1.12); P = 0.13], 30-day stroke [RR, 0.89 (95% CI, 0.47-1.67); P = 0.71], 30-day target vessel revascularization [RR, 0.74 (95% CI, 0.37-1.47); P = 0.39], 30-day stent thrombosis [RR, 1.08 (95% CI, 0.75-1.57); P = 0.67], and 30-day bleeding [RR, 1.25 (95% CI, 0.83-1.88); P = 0.29] compared with no AC. This meta-analysis concludes that there are no benefits of routine PPAC after PCI in AMI. The decision to prolong anticoagulant use post-PCI depends on risk versus benefits, which vary from case to case. Future large-scale multicentric randomized trials are warranted to corroborate the results of this meta-analysis.