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Combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials

BACKGROUND: Despite numerous randomized clinical trials (RCT), data regarding the efficacy of antiplatelet and anticoagulant combinations are still conflicting. We aimed to analyze treatment options tested in various fields of cardiovascular prevention, regarding their efficacy and bleeding risk. ME...

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Autores principales: Szapáry, László, Tornyos, Dániel, Kupó, Péter, Lukács, Réka, El Alaoui El Abdallaoui, Oumaima, Komócsi, András
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9773199/
https://www.ncbi.nlm.nih.gov/pubmed/36568540
http://dx.doi.org/10.3389/fcvm.2022.1036609
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author Szapáry, László
Tornyos, Dániel
Kupó, Péter
Lukács, Réka
El Alaoui El Abdallaoui, Oumaima
Komócsi, András
author_facet Szapáry, László
Tornyos, Dániel
Kupó, Péter
Lukács, Réka
El Alaoui El Abdallaoui, Oumaima
Komócsi, András
author_sort Szapáry, László
collection PubMed
description BACKGROUND: Despite numerous randomized clinical trials (RCT), data regarding the efficacy of antiplatelet and anticoagulant combinations are still conflicting. We aimed to analyze treatment options tested in various fields of cardiovascular prevention, regarding their efficacy and bleeding risk. METHODS: Systematic searches of electronic databases were conducted until June 2022. A component network meta-analysis was performed in R. Risk estimates across trials were pooled using random-effects model selecting risk ratio (RR) with 95% confidence intervals (95% CIs) as summary statistics. The primary endpoint of interest was the rate of major cardiac adverse events (MACE). Major bleeding events were assessed as main safety endpoint. Secondary outcomes included cardiovascular- and overall mortality, myocardial infarction (MI), stent thrombosis, and stroke. RESULTS: Fifteen studies randomizing 73,536 patients were identified. The MACE risk reflected heterogeneity among the anticoagulants with dabigatran and apixaban significantly reducing the risk of MACE (RR 0.56; 95% CI 0.39–0.80 and RR 0.75; 95% CI 0.58–0.98, respectively). Vitamin K antagonist (VKA), rivaroxaban, or edoxaban did not reduced of MACE while it was associated with a significant increase of bleeding risk (RR 1.66; 3.66, and 5.47, respectively). The direct anticoagulant (DOAC) dose reduction resulted in tendencies of fewer bleeding but higher MACE risk, while combination with aspirin was followed with increased risk for bleeding, however, remained non-significant in these cases. CONCLUSION: Our meta-analysis supports that the ischemic-bleeding balance is different among direct-acting oral anticoagulants (DOACs) while this is not significantly affected by the dose reduction approaches. Long-term aspirin treatment as part of the anticoagulant and dual antiplatelet regimen provides no ischemic benefit but may increase bleeding risk. SYSTEMATIC REVIEW REGISTRATION: [https://www.crd.york.ac.uk/prospero/], identifier [259703].
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spelling pubmed-97731992022-12-23 Combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials Szapáry, László Tornyos, Dániel Kupó, Péter Lukács, Réka El Alaoui El Abdallaoui, Oumaima Komócsi, András Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Despite numerous randomized clinical trials (RCT), data regarding the efficacy of antiplatelet and anticoagulant combinations are still conflicting. We aimed to analyze treatment options tested in various fields of cardiovascular prevention, regarding their efficacy and bleeding risk. METHODS: Systematic searches of electronic databases were conducted until June 2022. A component network meta-analysis was performed in R. Risk estimates across trials were pooled using random-effects model selecting risk ratio (RR) with 95% confidence intervals (95% CIs) as summary statistics. The primary endpoint of interest was the rate of major cardiac adverse events (MACE). Major bleeding events were assessed as main safety endpoint. Secondary outcomes included cardiovascular- and overall mortality, myocardial infarction (MI), stent thrombosis, and stroke. RESULTS: Fifteen studies randomizing 73,536 patients were identified. The MACE risk reflected heterogeneity among the anticoagulants with dabigatran and apixaban significantly reducing the risk of MACE (RR 0.56; 95% CI 0.39–0.80 and RR 0.75; 95% CI 0.58–0.98, respectively). Vitamin K antagonist (VKA), rivaroxaban, or edoxaban did not reduced of MACE while it was associated with a significant increase of bleeding risk (RR 1.66; 3.66, and 5.47, respectively). The direct anticoagulant (DOAC) dose reduction resulted in tendencies of fewer bleeding but higher MACE risk, while combination with aspirin was followed with increased risk for bleeding, however, remained non-significant in these cases. CONCLUSION: Our meta-analysis supports that the ischemic-bleeding balance is different among direct-acting oral anticoagulants (DOACs) while this is not significantly affected by the dose reduction approaches. Long-term aspirin treatment as part of the anticoagulant and dual antiplatelet regimen provides no ischemic benefit but may increase bleeding risk. SYSTEMATIC REVIEW REGISTRATION: [https://www.crd.york.ac.uk/prospero/], identifier [259703]. Frontiers Media S.A. 2022-12-08 /pmc/articles/PMC9773199/ /pubmed/36568540 http://dx.doi.org/10.3389/fcvm.2022.1036609 Text en Copyright © 2022 Szapáry, Tornyos, Kupó, Lukács, El Alaoui El Abdallaoui and Komócsi. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Szapáry, László
Tornyos, Dániel
Kupó, Péter
Lukács, Réka
El Alaoui El Abdallaoui, Oumaima
Komócsi, András
Combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials
title Combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials
title_full Combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials
title_fullStr Combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials
title_full_unstemmed Combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials
title_short Combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials
title_sort combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9773199/
https://www.ncbi.nlm.nih.gov/pubmed/36568540
http://dx.doi.org/10.3389/fcvm.2022.1036609
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