Nine studies (1,996 participants, range 82 to 515) were included in the review. The authors reported that methodological features varied and larger trials demonstrated higher quality. No further details of study quality were presented.
Triple antithrombotic therapy was superior to dual antiplatelet therapy in the prevention of MACE (OR 0.60, 95% CI 0.42 to 0.86, I2=33%; seven studies) and reduction of all-cause mortality (OR 0.59, 95% CI 0.39 to 0.90, I2=0%; six studies). There were no significant differences in incidence of ischaemic stroke, but a trend towards higher incidence was noted for dual antiplatelet therapy (four studies).
Risk of major bleeding in the first six months was significantly higher with triple antithrombotic therapy (OR 2.12, 95% CI 1.05 to 4.29, I2=45%; five studies). A trend was noted for triple antithrombotic therapy and higher incidence of minor bleeding (four studies).
There was no evidence of publication bias.