Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis
Abstract Background Dual antiplatelet therapy (DAPT) is key for preventing ischaemic events post‐percutaneous coronary intervention (PCI). Various DAPT modifications like the shortened duration or P2Y12 inhibitor (P2Y12i) de‐escalation are implemented to reduce bleeding risk. However, these strategi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-12-01
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| Series: | Chronic Diseases and Translational Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cdt3.85 |
| _version_ | 1797644278661382144 |
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| author | Yuttana Wongsalap Kirati Kengkla Preyanate Wilairat Khemanat Ratworawong Surasak Saokaew Chaisiri Wanlapakorn |
| author_facet | Yuttana Wongsalap Kirati Kengkla Preyanate Wilairat Khemanat Ratworawong Surasak Saokaew Chaisiri Wanlapakorn |
| author_sort | Yuttana Wongsalap |
| collection | DOAJ |
| description | Abstract Background Dual antiplatelet therapy (DAPT) is key for preventing ischaemic events post‐percutaneous coronary intervention (PCI). Various DAPT modifications like the shortened duration or P2Y12 inhibitor (P2Y12i) de‐escalation are implemented to reduce bleeding risk. However, these strategies lack direct comparative studies. This study aimed to assess the efficacy and safety of such DAPT strategies, including de‐escalated and short DAPT, in patients undergoing PCI. Methods We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for relevant randomized controlled trials (RCTs). We performed a network meta‐analysis (NMA) to estimate risk ratios (RRs) and 95% confidence intervals (CIs). The primary efficacy endpoint was major adverse cardiac events (MACEs), and the primary safety endpoint was major bleeding. Secondary endpoints included individual components of MACEs and net adverse clinical events (NACEs). Results A total of 17 RCTs comprising 53,156 patients (median age, 62.0 years, 24.8% female) were included. NMA suggested that de‐escalation DAPT was associated with a significantly lower risk of MACEs (risk ratio [RR] = 0.79, 95% confidence interval [CI] = 0.64–0.98), bleeding (RR = 0.63, 95% CI = 0.49–0.82), and NACEs (RR = 0.69, 95% CI = 0.60–0.79) compared with standard DAPT. Short DAPT followed by P2Y12i monotherapy exhibited a significantly decreased risk of major bleeding (RR = 0.63, 95% CI = 0.46–0.86) compared with standard DAPT. Conclusions De‐escalation DAPT was the most effective strategy for preventing the risk of MACEs without increasing bleeding events, while short DAPT followed by P2Y12i monotherapy was the most effective strategy for reducing the risk of bleeding among patients undergoing PCI. |
| first_indexed | 2024-03-11T14:28:10Z |
| format | Article |
| id | doaj.art-6518c230976743e78451aa65e42d9b50 |
| institution | Directory Open Access Journal |
| issn | 2589-0514 |
| language | English |
| last_indexed | 2024-03-11T14:28:10Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Chronic Diseases and Translational Medicine |
| spelling | doaj.art-6518c230976743e78451aa65e42d9b502023-10-31T12:57:43ZengWileyChronic Diseases and Translational Medicine2589-05142023-12-019429930810.1002/cdt3.85Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysisYuttana Wongsalap0Kirati Kengkla1Preyanate Wilairat2Khemanat Ratworawong3Surasak Saokaew4Chaisiri Wanlapakorn5Division of Clinical Pharmacy, Department of Pharmaceutical Care University of Phayao Phayao ThailandDivision of Clinical Pharmacy, Department of Pharmaceutical Care University of Phayao Phayao ThailandDivision of Clinical Pharmacy, Department of Pharmaceutical Care University of Phayao Phayao ThailandDivision of Clinical Pharmacy, Department of Pharmaceutical Care University of Phayao Phayao ThailandCenter of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences University of Phayao Phayao ThailandCardiac Centre, King Chulalongkorn Memorial Hospital Krung Thep Maha Nakorn ThailandAbstract Background Dual antiplatelet therapy (DAPT) is key for preventing ischaemic events post‐percutaneous coronary intervention (PCI). Various DAPT modifications like the shortened duration or P2Y12 inhibitor (P2Y12i) de‐escalation are implemented to reduce bleeding risk. However, these strategies lack direct comparative studies. This study aimed to assess the efficacy and safety of such DAPT strategies, including de‐escalated and short DAPT, in patients undergoing PCI. Methods We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for relevant randomized controlled trials (RCTs). We performed a network meta‐analysis (NMA) to estimate risk ratios (RRs) and 95% confidence intervals (CIs). The primary efficacy endpoint was major adverse cardiac events (MACEs), and the primary safety endpoint was major bleeding. Secondary endpoints included individual components of MACEs and net adverse clinical events (NACEs). Results A total of 17 RCTs comprising 53,156 patients (median age, 62.0 years, 24.8% female) were included. NMA suggested that de‐escalation DAPT was associated with a significantly lower risk of MACEs (risk ratio [RR] = 0.79, 95% confidence interval [CI] = 0.64–0.98), bleeding (RR = 0.63, 95% CI = 0.49–0.82), and NACEs (RR = 0.69, 95% CI = 0.60–0.79) compared with standard DAPT. Short DAPT followed by P2Y12i monotherapy exhibited a significantly decreased risk of major bleeding (RR = 0.63, 95% CI = 0.46–0.86) compared with standard DAPT. Conclusions De‐escalation DAPT was the most effective strategy for preventing the risk of MACEs without increasing bleeding events, while short DAPT followed by P2Y12i monotherapy was the most effective strategy for reducing the risk of bleeding among patients undergoing PCI.https://doi.org/10.1002/cdt3.85de‐escalationpercutaneous coronary interventionshort dual antiplatelet therapy |
| spellingShingle | Yuttana Wongsalap Kirati Kengkla Preyanate Wilairat Khemanat Ratworawong Surasak Saokaew Chaisiri Wanlapakorn Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis Chronic Diseases and Translational Medicine de‐escalation percutaneous coronary intervention short dual antiplatelet therapy |
| title | Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis |
| title_full | Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis |
| title_fullStr | Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis |
| title_full_unstemmed | Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis |
| title_short | Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis |
| title_sort | efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention a systematic review and network meta analysis |
| topic | de‐escalation percutaneous coronary intervention short dual antiplatelet therapy |
| url | https://doi.org/10.1002/cdt3.85 |
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