Key result
Indobufen-based DAPT cuts BARC 2-5 bleeding ~37% vs aspirin-based DAPT with similar ischemic events.
Why the study?
Indobufen is a potential alternative to aspirin in DAPT regimens after PCI, prompting a comparison of the efficacy and safety of indobufen-based versus aspirin-based DAPT following PCI.
Does indobufen-based DAPT reduce bleeding and maintain ischemic efficacy compared to aspirin-based DAPT in patients following PCI?
Meta-Analysis (n=13,044)
Does indobufen-based DAPT reduce bleeding and maintain ischemic efficacy compared to aspirin-based DAPT in patients following PCI?
Relative Risk: 0.63 (95% CI 0.45–0.9)
Indobufen-based DAPT offers a safer alternative to aspirin-based DAPT post-PCI by reducing bleeding and gastrointestinal adverse events without compromising ischemic efficacy.
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Supports indobufen as safer DAPT alternative post-PCI; extends RCT evidence by confirming lower bleeding without ischemic differences.
Background: Indobufen is a potential alternative to aspirin in dual antiplatelet therapy (DAPT) regimens after percutaneous coronary intervention (PCI) due to its superior safety profile and comparable efficacy. This systematic review and meta-analysis compares the efficacy and safety of indobufen-based DAPT versus aspirin-based DAPT following PCI. Methods: A systematic literature search was conducted on PubMed, Embase, Cochrane, and ClinicalTrials.gov using MeSH terms and keywords related to “Percutaneous Coronary Intervention,” “Platelet Aggregation Inhibitors,” and “Aspirin,” from inception to March 2026. Randomized controlled trials (RCTs) and cohort studies assessing indobufen post-PCI were included. A random-effects meta-analysis was performed using the Mantel–Haenszel method in RevMan to pool risk ratios (RR) and 95% confidence intervals (CIs). Results: Six studies comprising 13 044 patients were included. Indobufen use significantly reduced Bleeding Academic Research Consortium (BARC) type 2 bleeding (RR = 0.57, 95% CI 0.33–0.97), BARC type 2, 3, and 5 bleeding (RR = 0.63, 95% CI 0.45–0.90), and gastrointestinal adverse events (RR = 0.64, 95% CI 0.51–0.80). No significant differences were observed between both groups for cardiac death (RR = 1.23, 95% CI 0.72–2.12), myocardial infarction (RR = 0.92, 95% CI 0.52–1.64), ischemic stroke (RR = 0.90, 95% CI 0.58–1.39), stent thrombosis (RR = 1.12, 95% CI 0.45–2.82), and BARC type 3 or 5 bleeding (RR = 0.83, 95% CI 0.57–1.22). Conclusion: Indobufen demonstrates comparable antiplatelet efficacy to aspirin while improving safety. Further large-scale, high-quality RCTs are warranted to solidify evidence and inform future guidelines, particularly to assess the role of indobufen in patients at high bleeding risk.
Khalid et al. (2026) conducted a meta-analysis in Post-percutaneous coronary intervention (PCI) (n=13,044). Indobufen-based dual antiplatelet therapy vs. Aspirin-based dual antiplatelet therapy was evaluated on BARC type 2, 3, and 5 bleeding (RR 0.63, 95% CI 0.45-0.90). Indobufen-based DAPT significantly reduced BARC type 2, 3, and 5 bleeding compared to aspirin-based DAPT (RR 0.63; 95% CI 0.45-0.90) with no significant difference in ischemic events.
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