Comparison between mono vs dual vs triple antiplatelet therapy in patients with ischemic heart disease undergoing PCI, a network meta-analysis

• Published in: Current problems in cardiology Vol. 49; no. 11; p. 102755
• Main Authors: Al-Shammari, Ali Saad, Ibrahim, Ahmed, Shalabi, Laila, Khan, Misha, Rafiqul Islam, M., Alsawadi, Razan Adib, Almansouri, Naiela Ennaji, Hasan, Mohammed Tarek, Hassan, Ibrahim A., Sakini, Ahmed Sermed Al, Kanagala, Sai Gautham, Nada, Sarah A., Wssawi, Ameer Fadhel Al
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.11.2024
• Subjects: Antiplatelet therapy; Ischemic heart disease; Percutaneous coronary intervention; Antiplatelet therapy; Ischemic heart disease; Percutaneous coronary intervention
• ISSN: 0146-2806; 1535-6280; 1535-6280
• DOI: 10.1016/j.cpcardiol.2024.102755

We aim to research the efficacy and safety of single(SAPT), dual(DAPT), and triple(TAPT) antiplatelets approaches across IHD patients undergoing PCI. A network meta-analysis was conducted until April 1st, 2024, using the netmeta package in R studio 4.3.3. Primary outcomes were cardiac death, myocardial infarction(MI), stent thrombosis, stroke, and major bleeding(BARC 3-5). From 25 studies, a total of 65115 patients were included. For cardiac death, TAPT had no different risk than DAPT compared to SAPT [RR = 0.74; 95%CI (0.40 to 1.35); p-value = 0.33], [RR = 1.01, 95%CI (0.84 to 1.19); p-value = 0.87] respectively. For MI, TAPT had no different risk than DAPT compared to SAPT [RR = 0.77; 95%CI (0.51 to 1.16); p-value = 0.2047], [RR = 0.81, 95%CI (0.64 to 1.03); p-value = 0.0850] respectively. For stent thrombosis, DAPT had no different risk than TAPT compared to SAPT [RR = 0.74; 95%CI (0.45 to 1.21); p-value = 0.2284], [RR = 0.84, 95%CI (0.27 to 2.59); p-value = 0.7630] respectively. For stroke, DAPT had no different risk than TAPT in comparison to SAPT [RR = 0.91; 95%CI (0.75 to 1.10); p-value = 0.3209], and [RR = 0.87, 95%CI (0.43 to 1.76); p-value=0.6937], respectively. For Major bleeding(BARC 3-5), DAPT and TAPT increased major bleeding compared to SAPT, with only DAPT showing statistical significance. [RR = 1.43; 95%CI (1.09 to 1.88); p-value = 0.0107], and [RR = 2.78, 95%CI (0.90 to 4.78); p-value = 0.0852], respectively. DAPT and TAPT increased the risk of bleeding events compared to SAPT. However, we found no significant differences between these regimens for the other primary outcomes.