P2Y12 inhibitor monotherapy and dual antiplatelet therapy after percutaneous coronary intervention: An updated meta-analysis of randomized trials. Issue 198 (February 2021)

• Record Type: Journal Article
• Authors: Jin, Yao; Huang, Hui; Shu, Xinyi; Chen, Shuai; Lu, Lin; Gao, Xiang; Wu, Zhijun
• Is Part Of: Thrombosis research. Issue 198(2021)
• Page Start: 115
• Page End: 121
• Publication Date: 2021-02
• Subjects: Dual antiplatelet therapy -- P2Y12 inhibitor -- Ticagrelor -- Clopidogrel -- Prasugrel; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2020.11.038
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Long-term dual antiplatelet therapy (DAPT) has substantially reduced the risk of post-percutaneous coronary intervention (PCI) myocardial infarction and stent thrombosis at the expense of major bleeding. We hypothesized that a short-term DAPT followed by extended P2Y12 inhibitor monotherapy might be appropriate for patients with both high ischemic and bleeding risks. Materials and methods: We searched the databases: Pubmed, EMBASE, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov to identify randomized trials assessing the antiplatelet strategies after PCI. The primary safety endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The efficacy outcome was a composite of all-cause mortality/cardiovascular disease (CVD) death, myocardial infarction, or stroke. A random-effect model was used to calculate the pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Results: We identified 5 randomized trials comparing P2Y12 inhibitor monotherapy with standard DAPT (12 months) (16, 057 versus 16, 088). P2Y12 inhibitor monotherapy following short-term DAPT (1 to 3 months) significantly reduced the risk of BARC type 3 or 5 bleeding compared to standard DAPT (pooled HR: 0.63, 95%CI: 0.46–0.86). The difference between P2Y12 inhibitor monotherapy and standard DAPT in reducing the composite CVD outcomes was not statistically significant (HR: 0.88, 95%CI: 0.77–1.01). Conclusions: P2Y12 inhibitor monotherapy might be an effective strategy for lowering severe bleeding complications and simultaneously preserving the ischemic benefit in patients receiving PCI. Highlights: Long-term DAPT reduced the risk of post-PCI myocardial infarction and stent thrombosis at the cost of major bleeding. The P2Y12 inhibitors reduced the risk of recurrent ischemic events with similar or less bleeding risk compared to aspirin. P2Y12 inhibitor monotherapy after short-term DAPT can be used for patients with both high ischemic and bleeding risks.