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Mortality of Escalation and Modulation Antithrombotic Therapy in Coronary Artery Disease Patients: A Meta-analysis of Randomized Controlled Trials
Background The net clinical benefit of antithrombotic therapy (ATT) reflects the concomitant effects of bleeding and ischemic events. Objectives We sought to assess the overall effect of the modulation or escalation of ATT on all-cause mortality as well as ischemic and bleeding events. Methods We...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Georg Thieme Verlag KG
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9831688/ https://www.ncbi.nlm.nih.gov/pubmed/36343638 http://dx.doi.org/10.1055/s-0042-1757405 |
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author | Shao, Qiao-Yu Wang, Zhi-Jian Ma, Xiao-Teng Wang, Yu-Fei Li, Qiu-Xuan Yang, Zhi Qiang Lin, Xu-Ze Pan, Liu Gao, Fei Yang, Li Xia Liang, Jing Zhou, Yu-Jie |
author_facet | Shao, Qiao-Yu Wang, Zhi-Jian Ma, Xiao-Teng Wang, Yu-Fei Li, Qiu-Xuan Yang, Zhi Qiang Lin, Xu-Ze Pan, Liu Gao, Fei Yang, Li Xia Liang, Jing Zhou, Yu-Jie |
author_sort | Shao, Qiao-Yu |
collection | PubMed |
description | Background The net clinical benefit of antithrombotic therapy (ATT) reflects the concomitant effects of bleeding and ischemic events. Objectives We sought to assess the overall effect of the modulation or escalation of ATT on all-cause mortality as well as ischemic and bleeding events. Methods We performed a meta-analysis of randomized controlled trials comparing escalation or modulation of ATT versus standard ATT in patients with coronary artery disease. A total of 32 studies with 160,659 subjects were enrolled in this analysis. Results Neither escalation nor modulation of ATT has significant effect on all-cause mortality (escalation: relative risk [RR]: 0.94, 95% confidence interval [CI]: 0.85–1.04; modulation: RR: 0.90; 95% CI: 0.81–1.01). Compared with standard ATT therapy, escalation of ATT was associated with lower risk of myocardial infarction (MI; RR: 0.84, 95% CI: 0.76–0.94), but had a higher risk of major or minor bleeding (RR: 1.38, 95% CI: 1.15–1.66). Modulation of ATT was associated with a similar risk of MI (RR: 1.07, 95% CI: 0.96–1.19), but a reduced risk for major or minor bleeding (RR: 0.58, 95% CI: 0.51–0.66). Meta-regression combining both escalation and modulation studies found that the heterogeneity of all-cause mortality was mainly attributed to the heterogeneity of major or minor bleeding (adjusted R-squared = 100.00%, p = 0.004), but not to MI. Conclusion Either escalation or modulation of ATT has little benefit in all-cause mortality. The variability of the treatment effects on all-cause mortality was mainly attributed to the variability of major or minor bleeding, but not to MI. |
format | Online Article Text |
id | pubmed-9831688 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Georg Thieme Verlag KG |
record_format | MEDLINE/PubMed |
spelling | pubmed-98316882023-01-11 Mortality of Escalation and Modulation Antithrombotic Therapy in Coronary Artery Disease Patients: A Meta-analysis of Randomized Controlled Trials Shao, Qiao-Yu Wang, Zhi-Jian Ma, Xiao-Teng Wang, Yu-Fei Li, Qiu-Xuan Yang, Zhi Qiang Lin, Xu-Ze Pan, Liu Gao, Fei Yang, Li Xia Liang, Jing Zhou, Yu-Jie Thromb Haemost Background The net clinical benefit of antithrombotic therapy (ATT) reflects the concomitant effects of bleeding and ischemic events. Objectives We sought to assess the overall effect of the modulation or escalation of ATT on all-cause mortality as well as ischemic and bleeding events. Methods We performed a meta-analysis of randomized controlled trials comparing escalation or modulation of ATT versus standard ATT in patients with coronary artery disease. A total of 32 studies with 160,659 subjects were enrolled in this analysis. Results Neither escalation nor modulation of ATT has significant effect on all-cause mortality (escalation: relative risk [RR]: 0.94, 95% confidence interval [CI]: 0.85–1.04; modulation: RR: 0.90; 95% CI: 0.81–1.01). Compared with standard ATT therapy, escalation of ATT was associated with lower risk of myocardial infarction (MI; RR: 0.84, 95% CI: 0.76–0.94), but had a higher risk of major or minor bleeding (RR: 1.38, 95% CI: 1.15–1.66). Modulation of ATT was associated with a similar risk of MI (RR: 1.07, 95% CI: 0.96–1.19), but a reduced risk for major or minor bleeding (RR: 0.58, 95% CI: 0.51–0.66). Meta-regression combining both escalation and modulation studies found that the heterogeneity of all-cause mortality was mainly attributed to the heterogeneity of major or minor bleeding (adjusted R-squared = 100.00%, p = 0.004), but not to MI. Conclusion Either escalation or modulation of ATT has little benefit in all-cause mortality. The variability of the treatment effects on all-cause mortality was mainly attributed to the variability of major or minor bleeding, but not to MI. Georg Thieme Verlag KG 2022-11-07 /pmc/articles/PMC9831688/ /pubmed/36343638 http://dx.doi.org/10.1055/s-0042-1757405 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited. |
spellingShingle | Shao, Qiao-Yu Wang, Zhi-Jian Ma, Xiao-Teng Wang, Yu-Fei Li, Qiu-Xuan Yang, Zhi Qiang Lin, Xu-Ze Pan, Liu Gao, Fei Yang, Li Xia Liang, Jing Zhou, Yu-Jie Mortality of Escalation and Modulation Antithrombotic Therapy in Coronary Artery Disease Patients: A Meta-analysis of Randomized Controlled Trials |
title | Mortality of Escalation and Modulation Antithrombotic Therapy in Coronary Artery Disease Patients: A Meta-analysis of Randomized Controlled Trials |
title_full | Mortality of Escalation and Modulation Antithrombotic Therapy in Coronary Artery Disease Patients: A Meta-analysis of Randomized Controlled Trials |
title_fullStr | Mortality of Escalation and Modulation Antithrombotic Therapy in Coronary Artery Disease Patients: A Meta-analysis of Randomized Controlled Trials |
title_full_unstemmed | Mortality of Escalation and Modulation Antithrombotic Therapy in Coronary Artery Disease Patients: A Meta-analysis of Randomized Controlled Trials |
title_short | Mortality of Escalation and Modulation Antithrombotic Therapy in Coronary Artery Disease Patients: A Meta-analysis of Randomized Controlled Trials |
title_sort | mortality of escalation and modulation antithrombotic therapy in coronary artery disease patients: a meta-analysis of randomized controlled trials |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9831688/ https://www.ncbi.nlm.nih.gov/pubmed/36343638 http://dx.doi.org/10.1055/s-0042-1757405 |
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