Key result
Early antithrombotic therapy with aspirin significantly reduced MACE compared to placebo (OR 0.57; 95% CI 0.34-0.96) in NSTE-ACS, with other combinations also showing significant efficacy.
Why the study?
Evaluating the safety and efficacy profiles of all guideline-recommended initial antithrombotic therapy combinations remains crucial for early management in medically and invasively treated NSTE-ACS patients.
Do various combinations of early antithrombotic therapy improve early MACE and major bleeding in patients with NSTE-ACS?
Meta-Analysis (n=88,748)
Do various combinations of early antithrombotic therapy improve early MACE and major bleeding in patients with NSTE-ACS?
This meta-analysis provides a comprehensive safety and efficacy profile of various early antithrombotic therapy combinations in NSTE-ACS, supporting the use of more potent P2Y12 inhibitors and LMWH/fondaparinux to balance ischemic and bleeding risks.
Answers are grounded in this paper and cite their sources.
Supports early aspirin in NSTE-ACS to reduce MACE; extends evidence on antithrombotic combinations balancing ischemic and bleeding risks.
AIMS: Despite the increasing use of early invasive strategies in non-ST-elevation acute coronary syndromes (NSTE-ACS), optimal initial antithrombotic therapy (ATT) based on the safety/efficacy profile of all guideline-recommended combinations remains crucial for the early management of both medically and invasively treated NSTE-ACS patients. METHODS AND RESULTS: Randomized controlled trials on ATT in NSTE-ACS/unstable angina reporting early (within 14 days) major adverse cardiovascular events (MACE) and major bleeding were selected. Overall, 3799 studies were screened, 117 clinical trials were assessed as potentially eligible, 20 trials were included in the study. According to treatment and type of intervention, nine different meta-analyses were performed including a total of 88 748 patients. A significant reduction of trial-defined MACE was found for aspirin vs. placebo [odds ratio (OR), 0.57; 95% confidence interval (CI), 0.34-0.96], heparin vs. placebo (OR, 0.38; 95% CI, 0.15-0.97), aspirin + heparin vs. placebo (OR, 0.32; 95% CI, 0.18-0.59), aspirin + heparin vs. aspirin (OR, 0.57; 95% CI, 0.42-0.79), aspirin + low molecular weight heparin (LMWH) vs. aspirin + unfractionated heparin (UFH; OR, 0.81; 95% CI, 0.69-0.95) and aspirin + ticagrelor/prasugrel + heparins vs. aspirin + clopidogrel + heparins (OR, 0.76; 95% CI, 0.62-0.94). A significant decrease in major bleeding was found only for fondaparinux vs. LMWH on the background of aspirin + clopidogrel (OR, 0.52; 95% CI, 0.44-0.62) despite a clear trend towards increased bleeding for heparin compared to aspirin, aspirin + heparin compared to placebo, aspirin + heparin compared to aspirin, aspirin + P2Y12inhibitors + UFH/LMWH compared to aspirin + UFH/LMWH, and aspirin + ticagrelor/prasugrel + heparins compared to aspirin + clopidogrel + heparins. CONCLUSION: To our knowledge, these findings are the first to report the safety and efficacy of all the various combinations of currently recommended ATT for the early management of NSTE-ACS, providing a comprehensive evidence-base to guide decisions depending on the patients' bleeding risk and treatment strategy.
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Galli et al. (2019) conducted a meta-analysis in non-ST-elevation acute coronary syndromes (NSTE-ACS) (n=88,748). Antithrombotic therapy (aspirin, heparin, LMWH, P2Y12 inhibitors) vs. Placebo or active comparators was evaluated on early (within 14 days) major adverse cardiovascular events (MACE) (OR 0.57, 95% CI 0.34-0.96). Early antithrombotic therapy with aspirin significantly reduced MACE compared to placebo (OR 0.57; 95% CI 0.34-0.96) in NSTE-ACS, with other combinations also showing significant efficacy.
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