P2Y12 Inhibitor vs Aspirin Monotherapy Following Dual Antiplatelet Therapy after Percutaneous Coronary Intervention: An Updated Meta-Analysis
With the publication of a large number of clinical studies on antiplatelet therapy in recent years, it is still controversial which antiplatelet monotherapy should be continued after a period of dual antiplatelet therapy (DAPT) in the post percutaneous coronary intervention (post-PCI) population. We...
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Published in | Reviews in cardiovascular medicine Vol. 24; no. 10; p. 284 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
IMR Press
01.10.2023
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Subjects | |
Online Access | Get full text |
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Summary: | With the publication of a large number of clinical studies on antiplatelet therapy in recent years, it is still controversial which antiplatelet monotherapy should be continued after a period of dual antiplatelet therapy (DAPT) in the post percutaneous coronary intervention (post-PCI) population. We conducted a meta-analysis to investigate the efficacy and safety of P2Y 12 inhibitors versus aspirin in the post-PCI population after completing DAPT.BackgroundWith the publication of a large number of clinical studies on antiplatelet therapy in recent years, it is still controversial which antiplatelet monotherapy should be continued after a period of dual antiplatelet therapy (DAPT) in the post percutaneous coronary intervention (post-PCI) population. We conducted a meta-analysis to investigate the efficacy and safety of P2Y 12 inhibitors versus aspirin in the post-PCI population after completing DAPT.We searched studies in electronic databases from January 1, 2015 to November 20, 2022. We conducted a meta-analysis to estimate the effect of P2Y 12 inhibitor monotherapy on clinical end-points in post-PCI patients after a period of DAPT, using trial-level data with consistent end-point definitions. The primary outcome was major adverse cardiovascular events (MACE). Odd ratio (OR) was pooled with 95% confidence interval (CI) for dichotomous data. This study is registered with INPLASY 2022120011.MethodsWe searched studies in electronic databases from January 1, 2015 to November 20, 2022. We conducted a meta-analysis to estimate the effect of P2Y 12 inhibitor monotherapy on clinical end-points in post-PCI patients after a period of DAPT, using trial-level data with consistent end-point definitions. The primary outcome was major adverse cardiovascular events (MACE). Odd ratio (OR) was pooled with 95% confidence interval (CI) for dichotomous data. This study is registered with INPLASY 2022120011.We included five studies that included 24,460 patients. The patients who received a P2Y 12 inhibitor showed a lower risk of MACE than patients who received aspirin (OR 0.70 [95% CI 0.60-0.80], I 2 = 0%, p < 0.00001) monotherapy. Subgroup analysis of MACE based on patient characteristics showed consistent results with the main analysis. The risk of major bleeding was similar in patients who received a P2Y 12 inhibitor and those who received aspirin (OR 0.86 [95% CI 0.53-1.39], I 2 = 57%, p = 0.54). The risk of major bleeding was borderline increased in patients who received ticagrelor versus aspirin (OR 1.81 [95% CI 0.99-3.31], p = 0.05).ResultsWe included five studies that included 24,460 patients. The patients who received a P2Y 12 inhibitor showed a lower risk of MACE than patients who received aspirin (OR 0.70 [95% CI 0.60-0.80], I 2 = 0%, p < 0.00001) monotherapy. Subgroup analysis of MACE based on patient characteristics showed consistent results with the main analysis. The risk of major bleeding was similar in patients who received a P2Y 12 inhibitor and those who received aspirin (OR 0.86 [95% CI 0.53-1.39], I 2 = 57%, p = 0.54). The risk of major bleeding was borderline increased in patients who received ticagrelor versus aspirin (OR 1.81 [95% CI 0.99-3.31], p = 0.05).In the post-PCI population, P2Y 12 inhibitor monotherapy may be superior to aspirin for MACE, repeat revascularization, and stroke without increasing the risk of major bleeding.ConclusionsIn the post-PCI population, P2Y 12 inhibitor monotherapy may be superior to aspirin for MACE, repeat revascularization, and stroke without increasing the risk of major bleeding. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 These authors contributed equally. |
ISSN: | 1530-6550 2153-8174 1530-6550 |
DOI: | 10.31083/j.rcm2410284 |