P2Y12 inhibitor monotherapy versus aspirin monotherapy after short-term dual antiplatelet therapy for percutaneous coronary intervention: Insights from a network meta-analysis of randomized trials

A number of trials have assessed the efficacy and safety of short-term dual antiplatelet therapy (DAPT) in patients who undergo percutaneous coronary intervention (PCI). However, whether to continue aspirin or a P2Y12 inhibitor after a short course of DAPT is actively debated. PUBMED and EMBASE were...

Full description

Saved in:
Bibliographic Details
Published in:The American heart journal 2020-09, Vol.227, p.82-90
Main Authors: Kuno, Toshiki, Ueyama, Hiroki, Takagi, Hisato, Bangalore, Sripal
Format: Article
Language:English
Subjects:
Angioplasty
Antiplatelet therapy
Aspirin
Aspirin - administration & dosage
Bleeding
Cerebral infarction
Clinical trials
Dual Anti-Platelet Therapy - methods
Evaluation
Health hazards
Humans
Implants
Inhibitors
Ischemia
Meta-analysis
Myocardial infarction
Network Meta-Analysis
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors - administration & dosage
Purinergic P2Y Receptor Antagonists - administration & dosage
Randomization
Randomized Controlled Trials as Topic
Safety
Search strategies
Sensitivity analysis
Short term
Stroke
Therapy
Thromboembolism
Thrombosis
Time Factors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A number of trials have assessed the efficacy and safety of short-term dual antiplatelet therapy (DAPT) in patients who undergo percutaneous coronary intervention (PCI). However, whether to continue aspirin or a P2Y12 inhibitor after a short course of DAPT is actively debated. PUBMED and EMBASE were searched through March 2020 for randomized controlled trials evaluating short-term DAPT (≤6 months) when compared with longer-term (≥12 months) DAPT among patients undergoing PCI. The ischemic outcomes were all-cause death, myocardial infarction, stent thrombosis, and stroke. The safety outcome was major and/or clinically relevant bleeding. The primary objective was to investigate the outcomes with aspirin monotherapy (Aspirin group) versus P2Y12 inhibitor monotherapy (P2Y12i group) after short-term DAPT. Our search identified 17 eligible trials enrolling a total of 54,625 patients comparing different DAPT duration. Either of the 2 monotherapy groups did not increase the risk of ischemic outcomes when compared with the long-term DAPT group, without difference between the Aspirin versus the P2Y12i groups. However, both monotherapy groups significantly reduced bleeding when compared with long-term DAPT (Aspirin group: hazard ratio [95% CI]: 0.62 [0.45-0.86], P=.004 and P2Y12i group: 0.68 [0.50-0.93], P=.015). There was no difference in bleeding between the Aspirin versus P2Y12i groups (hazard ratio=0.91 [0.58-1.43], P=.70). Among patients undergoing PCI, short-term DAPT with continuation of either aspirin or P2Y12i reduced bleeding without increasing ischemic outcomes when compared with long-term DAPT. The choice of antiplatelet therapy after short-term DAPT should be evaluated in well-powered trials.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2020.06.008