Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2022
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
_version_ 1784867897772867584
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
work_keys_str_mv AT shaoqiaoyu mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT wangzhijian mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT maxiaoteng mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT wangyufei mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT liqiuxuan mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT yangzhiqiang mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT linxuze mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT panliu mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT gaofei mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT yanglixia mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT liangjing mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials
AT zhouyujie mortalityofescalationandmodulationantithrombotictherapyincoronaryarterydiseasepatientsametaanalysisofrandomizedcontrolledtrials