P2Y12 inhibitor monotherapy after short DAPT post-PCI in ACS reduced NACE by 26% (IRR 0.74) and major bleeding by 53% compared to standard DAPT, unlike aspirin monotherapy.
Does short DAPT followed by P2Y12 inhibitor or aspirin monotherapy reduce net adverse clinical events in patients with ACS undergoing PCI compared to standard DAPT?
In patients with ACS undergoing PCI, short DAPT followed by P2Y12 inhibitor monotherapy significantly reduces net adverse clinical events and bleeding compared to aspirin monotherapy or standard DAPT.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background In patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), shortening dual antiplatelet therapy (DAPT) duration reduces bleeding, but the relative net benefit of aspirin versus P2Y12 inhibitor monotherapy is still debated. Purpose To evaluate the relative net benefits of aspirin versus P2Y12 inhibitor monotherapy after short DAPT. Methods Randomized trials of DAPT de-escalation by discontinuation in patients with ACS undergoing PCI were identified. Trial-defined net adverse clinical events (NACE), a composite of ischemic and bleeding events, was the primary outcome. Secondary outcomes included all-cause death and single components of the primary endpoint. Pairwise meta-analyses with interaction for the drug used as monotherapy were conducted as well as indirect comparisons through network meta-analysis using standard DAPT as a common comparator. Sensitivity analyses were performed to explore sources of heterogeneity. Results A total of 21 studies including 39,969 patients were included. Compared with standard DAPT, P2Y12 inhibitor monotherapy significantly reduced NACE (incidence rate ratio IRR 0.74; 95% confidence interval CI 0.60-0.92), any bleeding (IRR 0.55; 95% CI 0.45-0.68 for any bleeding), and major bleeding (IRR 0.47; 95% CI 0.37-0.61) while no significant differences were detected between aspirin monotherapy and standard DAPT (Figure 1). Significant interaction was detected for NACE (Pint=0.012) and any bleeding (Pint=0.009). At indirect comparison, P2Y12 inhibitor monotherapy was associated with lower rates of NACE (IRR 0.73; 95% CI 0.58-0.91) and any bleeding (IRR 0.67; 95% CI 0.48-0.96) compared with aspirin monotherapy (Figure 2). Conclusions In patients with ACS undergoing PCI, the benefits of short DAPT varied according to the subsequent monotherapy administered, with P2Y12 inhibitor monotherapy significantly reducing NACE, any bleeding and major bleeding, while aspirin monotherapy had neutral resultsFigure 1.Interaction analysis Figure 2.Indirect comparison
Laudani et al. (Sat,) reported a other. P2Y12 inhibitor monotherapy after short DAPT post-PCI in ACS reduced NACE by 26% (IRR 0.74) and major bleeding by 53% compared to standard DAPT, unlike aspirin monotherapy.