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Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis

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...

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Autores principales: Wongsalap, Yuttana, Kengkla, Kirati, Wilairat, Preyanate, Ratworawong, Khemanat, Saokaew, Surasak, Wanlapakorn, Chaisiri
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10617309/
https://www.ncbi.nlm.nih.gov/pubmed/37915393
http://dx.doi.org/10.1002/cdt3.85
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author Wongsalap, Yuttana
Kengkla, Kirati
Wilairat, Preyanate
Ratworawong, Khemanat
Saokaew, Surasak
Wanlapakorn, Chaisiri
author_facet Wongsalap, Yuttana
Kengkla, Kirati
Wilairat, Preyanate
Ratworawong, Khemanat
Saokaew, Surasak
Wanlapakorn, Chaisiri
author_sort Wongsalap, Yuttana
collection PubMed
description 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.
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spelling pubmed-106173092023-11-01 Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis Wongsalap, Yuttana Kengkla, Kirati Wilairat, Preyanate Ratworawong, Khemanat Saokaew, Surasak Wanlapakorn, Chaisiri Chronic Dis Transl Med Meta‐analysis 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. John Wiley and Sons Inc. 2023-07-27 /pmc/articles/PMC10617309/ /pubmed/37915393 http://dx.doi.org/10.1002/cdt3.85 Text en © 2023 The Authors. Chronic Diseases and Translational Medicine published by John Wiley & Sons Ltd on behalf of Chinese Medical Association. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Meta‐analysis
Wongsalap, Yuttana
Kengkla, Kirati
Wilairat, Preyanate
Ratworawong, Khemanat
Saokaew, Surasak
Wanlapakorn, Chaisiri
Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis
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 Meta‐analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10617309/
https://www.ncbi.nlm.nih.gov/pubmed/37915393
http://dx.doi.org/10.1002/cdt3.85
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