Key result
Long-term use of antiplatelet therapy in patients with Takotsubo syndrome was associated with a significantly higher incidence of the composite outcome (OR 1.54) and overall mortality (OR 1.72) compared to no antiplatelet therapy.
Why the study?
Antithrombotic therapy is still extensively prescribed in patients with Takotsubo syndrome despite recent evidence suggesting a lack of benefit, leaving unclear whether patients benefit in short- or long-term outcomes.
Does antiplatelet therapy improve long-term outcomes in patients with Takotsubo syndrome?
Meta-Analysis (n=1,997)
Does antiplatelet therapy improve long-term outcomes in patients with Takotsubo syndrome?
Answers are grounded in this paper and cite their sources.
Long-term antiplatelet therapy in Takotsubo syndrome is associated with increased mortality and adverse cardiovascular events, suggesting it should not be routinely prescribed without other strong indications.
While the most recent evidence suggests a lack of benefit, antithrombotic therapy is still extensively prescribed in patients with Takotsubo syndrome (TTS). The objective of this study was to determine whether patients with TTS benefit from anti-aggregation, in terms of either short-term or long-term outcomes. A systematic review and meta-analysis was conducted. A comprehensive search of the literature included MEDLINE, Cochrane Library, Clinicaltrials.gov, EU Clinical Trial Register, References, and contact with the authors. Methodological quality assessment and data extraction were systematically performed. The review adhered to the PRISMA framework guidelines. A total of 86 citations were identified, six being eligible for inclusion, for a total of 1997 patients. One of them considered both short-term and long-term outcomes. One reported outcomes during the index event, while the remaining four focused on potential long-term benefits. They were all retrospective cohort studies.Based on our data, the long-term use of antiplatelet therapy (AT) led to a significantly higher incidence of the composite outcome (OR: 1.54; 95% CI 1.09-2.17; p = 0.014) and overall mortality (OR 1.72; 95% CI 1.07-2.77; p = 0.027). The analysis did not show a statistically significant difference in TTS recurrences, stroke/TIA, and MI or CAD worsening with AT compared with no anti-aggregation. The AT in this settings did not show any clear benefit in improving the long-term outcomes, and it may be even detrimental and it may be detrimental. These results warrant further future research and the design of adequately powered randomized controlled trials focusing on the impact of aspirin on the outcomes in patients presenting with TTS.
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Rizzetto et al. (2021) conducted a meta-analysis in Takotsubo syndrome (n=1,997). Antiplatelet therapy vs. No antiplatelet therapy was evaluated on Long-term composite outcome (OR 1.54, 95% CI 1.09-2.17, p=0.014). Long-term use of antiplatelet therapy in patients with Takotsubo syndrome was associated with a significantly higher incidence of the composite outcome (OR 1.54) and overall mortality (OR 1.72) compared to no antiplatelet therapy.
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