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

2020 ◽  
Vol 227 ◽  
pp. 82-90 ◽  
Author(s):  
Toshiki Kuno ◽  
Hiroki Ueyama ◽  
Hisato Takagi ◽  
Sripal Bangalore
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Randomized Trials ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Short Term ◽  
P2y12 Inhibitor ◽  
Percutaneous Coronary

Abstract 15357: P2Y12 Inhibitor Monotherapy After Short-term Dual Antiplatelet Therapy in Patients Receiving Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ahmad Naeem Lone ◽  
Safi U Khan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Absolute Risk ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Short Term ◽  
P2y12 Inhibitor ◽  
Percutaneous Coronary ◽  
New Strategy

Introduction: The safety and effectiveness of new strategy of de-escalating short-term dual antiplatelet therapy (DAPT) (≤ 3-month) followed by P2Y12 inhibitor monotherapy versus 12-month DAPT after percutaneous coronary intervention (PCI) is unclear. Hypothesis: Short-term DAPT followed by P2Y12 inhibitor therapy might be safer and equally effective compared with 12-month DAPT. Methods: Five randomized controlled trials (n=32,181) comparing P2Y12 inhibitor monotherapy with DAPT after PCI were selected from MEDLINE and EMBASE databases through June 2020. Meta-analysis was performed using random effects model. Results are reported as absolute risk differences (ARDs) with 95% confidence intervals (CIs). Results: Short-term DAPT followed by P2Y12 monotherapy was associated with lesser risk of major bleeding compared with 12-month DAPT (ARD, -0.73% [95% CI, -1.32%, -0.14%]). There were no differences between all-cause mortality (ARD, -0.22% [95% CI, -0.50%, 0.07%]), cardiovascular mortality (ARD, -0.24% [95% CI, -0.51%, 0.03%]), myocardial infarction (ARD, -0.13% [95%CI, -0.40%, 0.14%]), MACE (ARD, -0.25% [95% CI, -0.73%, 0.24%]) and stroke (ARD, 0.03% (95% CI, -0.22%, 0.29%]). These results were consistent across use of clopidogrel or ticagrelor. Conclusions: Short term DAPT followed by P2Y12 inhibitor monotherapy after PCI is safer and equally effective compared with 12-month DAPT.

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