Fourteen RCTs (5,821 participants, range 59 to 1,212) were included. Follow-up in one trial was 24 months and in others ranged from six to 12 months.
Six RCTs were considered to be at low risk of bias and seven were considered to be at high risk of bias; quality was not reported for one trial.
Compared to dual antiplatelet therapy, triple antiplatelet therapy reduced major cardiovascular events (OR 0.59, 95% CI 0.46 to 0.76; Ι²=44%; 14 trials), the rate of target vessel revascularisation (OR 0.65, 95% CI 0.51 to 0.83; nine trials), target lesion revascularisation (OR 0.50, 95% CI 0.32 to 0.79; five trials), net adverse events (OR 0.69, 95% CI 0.55 to 0.86; 10 trials), binary stenosis (OR 0.53, 95% CI 0.42 to 0.67; eight trials) and a decrease in late lumen loss (WMD -0.17mm, 95% CI -0.21 to -0.12; seven trials) and diameter stenosis (WMD -5.41%, 95% CI -8.94 to -1.87; six trials). There was a reduction in cardiovascular thrombotic events that just failed to reach statistical significance (OR 0.61, 95% CI 0.37 to 1.00; six trials).
There were no statistically significant differences for all-cause death (14 trials), cardiac death (10 trials), myocardial infarction (12 trials), stent thrombosis (nine trials), major bleeding (10 trials) and total bleeding (13 trials).
Drug discontinuation occurred more frequently in the triple therapy groups (OR 3.62, 95% CI 1.88 to 6.95). Common side-effects included skin rash, headache, gastrointestinal disturbances and palpitations.
In subgroup analyses, results for major adverse cardiovascular events were similar to the main analysis for different subgroups of participants and with drug eluting stents but not with bare metal stents (where there was no statistically significant difference). Other subgroup analyses were reported.