Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials
Aimed to evaluate and compare the interactive effects of different antiplatelet or anticoagulation strategies in patients with chronic coronary syndromes (CCS) after percutaneous coronary intervention (PCI). Randomized controlled trials comparing different antiplatelet or anticoagulant strategies in...
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| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.992376/full |
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| author | Yaowang Lin Zhigang Cai Shaohong Dong Huadong Liu Xinli Pang Qiuling Chen Jie Yuan Qingshan Geng Qingshan Geng |
| author_facet | Yaowang Lin Zhigang Cai Shaohong Dong Huadong Liu Xinli Pang Qiuling Chen Jie Yuan Qingshan Geng Qingshan Geng |
| author_sort | Yaowang Lin |
| collection | DOAJ |
| description | Aimed to evaluate and compare the interactive effects of different antiplatelet or anticoagulation strategies in patients with chronic coronary syndromes (CCS) after percutaneous coronary intervention (PCI). Randomized controlled trials comparing different antiplatelet or anticoagulant strategies in patients with CCS after PCI were included. The primary outcomes were major adverse cardiovascular event (MACE), mortality, ischemic and bleeding events. Compared to aspirin alone, addition of prasugrel or ticagrelor to aspirin resulted in lower risk of myocardial infarction (MI) [odds ratio (OR): 0.38 (95% confidence interval 0.38–0.62); 0.810–0.84 (0.69–0.98)] and any stroke [0.56 (0.42–0.75)] at the expense of increased risk of major bleeding [1.79 (1.34–2.39); 2.08–2.38 (1.56–3.28)], whereas, clopidogrel monotherapy reduced the risk of any stroke, major bleeding, and intracranial bleeding. On subgroup analysis, compared with aspirin alone, addition of prasugrel resulted in lower MACE [0.72 (0.60–0.86)], MI [0.48 (0.38–0.62)], and stent thrombosis [0.29 (0.09–0.91)], whereas, addition of rivaroxaban 2.5 mg resulted in lower risk of MACE [0.72 (0.60–0.87)], cardiac death [0.71 (0.52–0.98)] and any stroke [0.65 (0.45–0.95)], but not reduced MI. Both prasugrel and rivaroxaban 2.5 mg increased major bleeding [1.79 (1.34–2.39); 1.72 (1.33–2.22)]. Clopidogrel monotherapy was associated with lower MACE [0.72 (0.58–0.90)], any stroke [0.42 (0.24–0.73)], and major bleeding [0.62 (0.40–0.96)]. Adding prasugrel or ticagrelor led to a reduced incidence of MI and prasugrel was also found to reduce the risk of MACE and stent thrombosis in CCS patients with low risk of bleeding after PCI. Clopidogrel monotherapy has advantage in reducing MACE, stroke, and major bleeding events in CCS patients at high risk of bleeding after PCI.Systematic Review Registration:https://clinicaltrials.gov/, PROSPERO Identifier: CRD 42021291050. |
| first_indexed | 2024-12-10T05:40:28Z |
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| id | doaj.art-c1dc12ebf8f74ef4ab719dfdf6829e3b |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-10T05:40:28Z |
| publishDate | 2022-09-01 |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-c1dc12ebf8f74ef4ab719dfdf6829e3b2022-12-22T02:00:19ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-09-011310.3389/fphar.2022.992376992376Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trialsYaowang Lin0Zhigang Cai1Shaohong Dong2Huadong Liu3Xinli Pang4Qiuling Chen5Jie Yuan6Qingshan Geng7Qingshan Geng8Department of Cardiology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen Key Medical Disciplin (SZXK003), Shenzhen, Guangdong, ChinaInstitution of Shenzhen Hospital, Guangzhou University of Chinese Medicine (Futian), Shenzhen, ChinaDepartment of Cardiology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen Key Medical Disciplin (SZXK003), Shenzhen, Guangdong, ChinaDepartment of Cardiology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen Key Medical Disciplin (SZXK003), Shenzhen, Guangdong, ChinaDepartment of Cardiology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen Key Medical Disciplin (SZXK003), Shenzhen, Guangdong, ChinaDepartment of Pharmacy, Shenzhen People’s Hospital, Shenzhen, Guangdong, ChinaDepartment of Cardiology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen Key Medical Disciplin (SZXK003), Shenzhen, Guangdong, ChinaDepartment of Cardiology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen Key Medical Disciplin (SZXK003), Shenzhen, Guangdong, ChinaDepartment of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, ChinaAimed to evaluate and compare the interactive effects of different antiplatelet or anticoagulation strategies in patients with chronic coronary syndromes (CCS) after percutaneous coronary intervention (PCI). Randomized controlled trials comparing different antiplatelet or anticoagulant strategies in patients with CCS after PCI were included. The primary outcomes were major adverse cardiovascular event (MACE), mortality, ischemic and bleeding events. Compared to aspirin alone, addition of prasugrel or ticagrelor to aspirin resulted in lower risk of myocardial infarction (MI) [odds ratio (OR): 0.38 (95% confidence interval 0.38–0.62); 0.810–0.84 (0.69–0.98)] and any stroke [0.56 (0.42–0.75)] at the expense of increased risk of major bleeding [1.79 (1.34–2.39); 2.08–2.38 (1.56–3.28)], whereas, clopidogrel monotherapy reduced the risk of any stroke, major bleeding, and intracranial bleeding. On subgroup analysis, compared with aspirin alone, addition of prasugrel resulted in lower MACE [0.72 (0.60–0.86)], MI [0.48 (0.38–0.62)], and stent thrombosis [0.29 (0.09–0.91)], whereas, addition of rivaroxaban 2.5 mg resulted in lower risk of MACE [0.72 (0.60–0.87)], cardiac death [0.71 (0.52–0.98)] and any stroke [0.65 (0.45–0.95)], but not reduced MI. Both prasugrel and rivaroxaban 2.5 mg increased major bleeding [1.79 (1.34–2.39); 1.72 (1.33–2.22)]. Clopidogrel monotherapy was associated with lower MACE [0.72 (0.58–0.90)], any stroke [0.42 (0.24–0.73)], and major bleeding [0.62 (0.40–0.96)]. Adding prasugrel or ticagrelor led to a reduced incidence of MI and prasugrel was also found to reduce the risk of MACE and stent thrombosis in CCS patients with low risk of bleeding after PCI. Clopidogrel monotherapy has advantage in reducing MACE, stroke, and major bleeding events in CCS patients at high risk of bleeding after PCI.Systematic Review Registration:https://clinicaltrials.gov/, PROSPERO Identifier: CRD 42021291050.https://www.frontiersin.org/articles/10.3389/fphar.2022.992376/fullantiplatelet therapychronic coronary syndromespercutaneous coronary interventionrandomized control trialsgeriatric diseaseanticoagulant |
| spellingShingle | Yaowang Lin Zhigang Cai Shaohong Dong Huadong Liu Xinli Pang Qiuling Chen Jie Yuan Qingshan Geng Qingshan Geng Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials Frontiers in Pharmacology antiplatelet therapy chronic coronary syndromes percutaneous coronary intervention randomized control trials geriatric disease anticoagulant |
| title | Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials |
| title_full | Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials |
| title_fullStr | Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials |
| title_full_unstemmed | Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials |
| title_short | Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials |
| title_sort | comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention a network meta analysis of randomized controlled trials |
| topic | antiplatelet therapy chronic coronary syndromes percutaneous coronary intervention randomized control trials geriatric disease anticoagulant |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.992376/full |
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