Key result
Triple antiplatelet therapy cuts MACE without increasing major bleeding versus DAPT in East Asian ACS patients.
Why the study?
Does dual or triple antiplatelet therapy improve major adverse cardiac events and major bleeding events in East Asian patients with acute coronary syndrome?
Does dual or triple antiplatelet therapy improve major adverse cardiac events and major bleeding events in East Asian patients with acute coronary syndrome?
In East Asian patients with acute coronary syndrome, triple antiplatelet therapy (adding cilostazol) reduces MACE without increasing bleeding, whereas potent P2Y12 inhibitor DAPT increases bleeding without reducing MACE unless a de-escalation strategy is used.
Supports cilostazol TAPT over potent DAPT in East Asian ACS; challenges uniform potent P2Y12 strategies.
This systematic review and network meta-analysis (NMA) evaluated the efficacy and safety of dual antiplatelet therapy (DAPT) and triple antiplatelet therapy (TAPT) in East Asian patients with acute coronary syndrome. Twenty-six randomized controlled trials comparing DAPT (P2Y12 inhibitor with aspirin) or TAPT (cilostazol with clopidogrel-based DAPT) were included from four databases. Primary outcomes were major adverse cardiac events (MACEs) and major bleeding events. Frequentist NMA was performed using RRs. The reference comparator was clopidogrel-based DAPT. TAPT significantly reduced MACEs without increasing major bleeding events. Standard-dose potent P2Y12 inhibitor-based DAPT showed no MACE reduction but significantly increased major bleeding events. TAPT had the highest probability of reducing MACEs, while DAPT incorporating potent P2Y12 inhibitors with de-escalation had the highest probability of minimizing major bleeding events. To conclude, TAPT demonstrates promising efficacy without compromising safety, while de-escalation strategies appear effective in balancing the efficacy and safety of DAPT.
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Ho et al. (2026) studied this question. Triple antiplatelet therapy significantly reduced major adverse cardiac events without increasing major bleeding in East Asian patients with acute coronary syndrome.
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