Efficacy and Safety of Long‐Term Antithrombotic Strategies in Patients With Chronic Coronary Syndrome: A Network Meta‐analysis of Randomized Controlled Trials
Background Long‐term antithrombotic strategies for patients with chronic coronary syndrome with high‐risk factors represent an important treatment dilemma in clinical practice. Our aim was to conduct a network meta‐analysis to evaluate the efficacy and safety of long‐term antithrombotic strategies i...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.019184 |
| _version_ | 1811333673779200000 |
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| author | Houyong Zhu Xiaoqun Xu Xiaojiang Fang Fei Ying Liuguang Song Beibei Gao Guoxin Tong Liang Zhou Tielong Chen Jinyu Huang |
| author_facet | Houyong Zhu Xiaoqun Xu Xiaojiang Fang Fei Ying Liuguang Song Beibei Gao Guoxin Tong Liang Zhou Tielong Chen Jinyu Huang |
| author_sort | Houyong Zhu |
| collection | DOAJ |
| description | Background Long‐term antithrombotic strategies for patients with chronic coronary syndrome with high‐risk factors represent an important treatment dilemma in clinical practice. Our aim was to conduct a network meta‐analysis to evaluate the efficacy and safety of long‐term antithrombotic strategies in patients with chronic coronary syndrome. Methods and Results Four randomized studies were included (n=75167; THEMIS [Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study], COMPASS [Cardiovascular Outcomes for People Using Anticoagulation Strategies], PEGASUS‐TIMI 54 [Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54], and DAPT [Dual Anti‐platelet Therapy]). The odds ratios (ORs) and 95% CIs) were calculated as the measure of effect size. The results of the network meta‐analysis showed that, compared with aspirin monotherapy, the ORs for trial‐defined major adverse cardiovascular and cerebrovascular events were 0.86; (95% CI, 0.80–0.93) for ticagrelor plus aspirin, 0.89 (95% CI, 0.78–1.02) for rivaroxaban monotherapy, 0.74 (95% CI, 0.64–0.85) for rivaroxaban plus aspirin, and 0.72 (95% CI, 0.60,–0.86) for thienopyridine plus aspirin. Compared with aspirin monotherapy, the ORs for trial‐defined major bleeding were 2.15 (95% CI, 1.78–2.59]) for ticagrelor plus aspirin, 1.51 (95% CI, 1.23–1.85) for rivaroxaban monotherapy, and 1.68 (95% CI, 1.37–2.05) for rivaroxaban plus aspirin. For death from any cause, the improvement effect of rivaroxaban plus aspirin was detected versus aspirin monotherapy (OR, 0.76; 95% CI, 0.65–0.90), ticagrelor plus aspirin (OR, 0.79; 95% CI, 0.66–0.95), rivaroxaban monotherapy (OR, 0.82; 95% CI, 0.69–0.97), and thienopyridine plus aspirin (OR, 0.58; 95% CI, 0.41–0.82) regimens. Conclusions All antithrombotic strategies combined with aspirin significantly reduced the incidence of major adverse cardiovascular and cerebrovascular events and increased the risk of major bleeding compared with aspirin monotherapy. Considering the outcomes of all ischemic and bleeding events and all‐cause mortality, rivaroxaban plus aspirin appears to be the preferred long‐term antithrombotic regimen for patients with chronic coronary syndrome and high‐risk factors. |
| first_indexed | 2024-04-13T16:56:26Z |
| format | Article |
| id | doaj.art-01be9b4b3142456bbb3d1c2ffe684b2a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:56:26Z |
| publishDate | 2021-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-01be9b4b3142456bbb3d1c2ffe684b2a2022-12-22T02:38:48ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-03-0110610.1161/JAHA.120.019184Efficacy and Safety of Long‐Term Antithrombotic Strategies in Patients With Chronic Coronary Syndrome: A Network Meta‐analysis of Randomized Controlled TrialsHouyong Zhu0Xiaoqun Xu1Xiaojiang Fang2Fei Ying3Liuguang Song4Beibei Gao5Guoxin Tong6Liang Zhou7Tielong Chen8Jinyu Huang9Department of Cardiology Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University Hangzhou Zhejiang ChinaAffiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine Zhejiang ChinaDepartment of Cardiology Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University Hangzhou Zhejiang ChinaDepartment of Cardiology Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University Hangzhou Zhejiang ChinaDepartment of Cardiology Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University Hangzhou Zhejiang ChinaThe Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine Hangzhou Zhejiang ChinaThe Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine Hangzhou Zhejiang ChinaThe Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine Hangzhou Zhejiang ChinaDepartment of Cardiology Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University Hangzhou Zhejiang ChinaThe Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine Hangzhou Zhejiang ChinaBackground Long‐term antithrombotic strategies for patients with chronic coronary syndrome with high‐risk factors represent an important treatment dilemma in clinical practice. Our aim was to conduct a network meta‐analysis to evaluate the efficacy and safety of long‐term antithrombotic strategies in patients with chronic coronary syndrome. Methods and Results Four randomized studies were included (n=75167; THEMIS [Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study], COMPASS [Cardiovascular Outcomes for People Using Anticoagulation Strategies], PEGASUS‐TIMI 54 [Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54], and DAPT [Dual Anti‐platelet Therapy]). The odds ratios (ORs) and 95% CIs) were calculated as the measure of effect size. The results of the network meta‐analysis showed that, compared with aspirin monotherapy, the ORs for trial‐defined major adverse cardiovascular and cerebrovascular events were 0.86; (95% CI, 0.80–0.93) for ticagrelor plus aspirin, 0.89 (95% CI, 0.78–1.02) for rivaroxaban monotherapy, 0.74 (95% CI, 0.64–0.85) for rivaroxaban plus aspirin, and 0.72 (95% CI, 0.60,–0.86) for thienopyridine plus aspirin. Compared with aspirin monotherapy, the ORs for trial‐defined major bleeding were 2.15 (95% CI, 1.78–2.59]) for ticagrelor plus aspirin, 1.51 (95% CI, 1.23–1.85) for rivaroxaban monotherapy, and 1.68 (95% CI, 1.37–2.05) for rivaroxaban plus aspirin. For death from any cause, the improvement effect of rivaroxaban plus aspirin was detected versus aspirin monotherapy (OR, 0.76; 95% CI, 0.65–0.90), ticagrelor plus aspirin (OR, 0.79; 95% CI, 0.66–0.95), rivaroxaban monotherapy (OR, 0.82; 95% CI, 0.69–0.97), and thienopyridine plus aspirin (OR, 0.58; 95% CI, 0.41–0.82) regimens. Conclusions All antithrombotic strategies combined with aspirin significantly reduced the incidence of major adverse cardiovascular and cerebrovascular events and increased the risk of major bleeding compared with aspirin monotherapy. Considering the outcomes of all ischemic and bleeding events and all‐cause mortality, rivaroxaban plus aspirin appears to be the preferred long‐term antithrombotic regimen for patients with chronic coronary syndrome and high‐risk factors.https://www.ahajournals.org/doi/10.1161/JAHA.120.019184chronic coronary syndromelong‐term antithrombotic strategiesprevious percutaneous coronary intervention |
| spellingShingle | Houyong Zhu Xiaoqun Xu Xiaojiang Fang Fei Ying Liuguang Song Beibei Gao Guoxin Tong Liang Zhou Tielong Chen Jinyu Huang Efficacy and Safety of Long‐Term Antithrombotic Strategies in Patients With Chronic Coronary Syndrome: A Network Meta‐analysis of Randomized Controlled Trials Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease chronic coronary syndrome long‐term antithrombotic strategies previous percutaneous coronary intervention |
| title | Efficacy and Safety of Long‐Term Antithrombotic Strategies in Patients With Chronic Coronary Syndrome: A Network Meta‐analysis of Randomized Controlled Trials |
| title_full | Efficacy and Safety of Long‐Term Antithrombotic Strategies in Patients With Chronic Coronary Syndrome: A Network Meta‐analysis of Randomized Controlled Trials |
| title_fullStr | Efficacy and Safety of Long‐Term Antithrombotic Strategies in Patients With Chronic Coronary Syndrome: A Network Meta‐analysis of Randomized Controlled Trials |
| title_full_unstemmed | Efficacy and Safety of Long‐Term Antithrombotic Strategies in Patients With Chronic Coronary Syndrome: A Network Meta‐analysis of Randomized Controlled Trials |
| title_short | Efficacy and Safety of Long‐Term Antithrombotic Strategies in Patients With Chronic Coronary Syndrome: A Network Meta‐analysis of Randomized Controlled Trials |
| title_sort | efficacy and safety of long term antithrombotic strategies in patients with chronic coronary syndrome a network meta analysis of randomized controlled trials |
| topic | chronic coronary syndrome long‐term antithrombotic strategies previous percutaneous coronary intervention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.019184 |
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