What question did this study set out to answer?

To evaluate the efficacy and safety of different antithrombotic strategies within and beyond 12 months after coronary revascularization or acute coronary syndrome.

March 1, 2023European Heart Journal - Cardiovascular PharmacotherapyOpen Access

Within and beyond 12-month efficacy and safety of antithrombotic strategies in patients with established coronary artery disease: two companion network meta-analyses of the 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association for Acute CardioVascular Care (ACVC), and European Association of Preventive Cardiology (EAPC)

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Why the study?

To appraise all available antithrombotic treatments within or after 12 months following coronary revascularization and/or acute coronary syndrome.

Do different antithrombotic strategies reduce cardiovascular mortality, MI, and stroke in patients with established coronary artery disease following revascularization or ACS?

Key Points

To evaluate the efficacy and safety of different antithrombotic strategies within and beyond 12 months after coronary revascularization or acute coronary syndrome.
Conducted two network meta-analyses pooling data across 43 trials (N = 189,261) for outcomes within 12 months and 19 trials (N = 139,086) for outcomes beyond 12 months.
Evaluated cardiovascular mortality, myocardial infarction, stroke, and bleeding outcomes across multiple single and combined antithrombotic regimens.
Within 12 months, cardiovascular mortality was reduced versus aspirin plus clopidogrel by ticagrelor 90 mg b.i.d. alone (HR, 0.66; 95% CI, 0.49–0.88), aspirin plus ticagrelor (HR, 0.85; 95% CI, 0.76–0.95), and aspirin plus clopidogrel plus rivaroxaban (HR, 0.66; 95% CI, 0.51–0.86), with only ticagrelor monotherapy avoiding increased bleeding risk.
Beyond 12 months, no treatment reduced mortality versus aspirin, but myocardial infarction was reduced by aspirin plus clopidogrel (HR, 0.68; 95% CI, 0.55–0.85) and P2Y12 inhibitor monotherapy (HR, 0.76; 95% CI, 0.61–0.95; ticagrelor: HR, 0.54; 95% CI, 0.32–0.92) without increased bleeding.
Beyond 12 months, stroke was significantly reduced versus aspirin by VKA (HR, 0.56; 95% CI, 0.44–0.76) and aspirin plus rivaroxaban 2.5 mg (HR, 0.58; 95% CI, 0.44–0.76), though bleeding risk was elevated across all combination therapies.

Structured PICO

Do different antithrombotic strategies reduce cardiovascular mortality, MI, and stroke in patients with established coronary artery disease following revascularization or ACS?

Population

328,347 patients with established coronary artery disease following coronary revascularization and/or acute coronary syndrome across 62 trials (43 trials with N=189,261 within 12 months; 19 trials with N=139,086 beyond 12 months).

Intervention

Various antithrombotic strategies including ticagrelor 90 mg b.i.d. monotherapy, aspirin plus ticagrelor 90 mg, aspirin plus clopidogrel plus rivaroxaban 2.5 mg b.i.d., P2Y12 inhibitor monotherapy, VKA, and aspirin plus rivaroxaban 2.5 mg.

Comparator

Aspirin plus clopidogrel (for within 12 months analysis) and aspirin monotherapy (for beyond 12 months analysis).

Outcome

Cardiovascular mortality, myocardial infarction (MI), stroke, and bleeding.hard clinical

Network meta-analyses suggest ticagrelor monotherapy within 12 months and P2Y12 monotherapy beyond 12 months optimize ischemic protection without increasing bleeding risk in CAD patients.

Discussion

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Implication

Supports preferring ticagrelor monotherapy within 12 months and P2Y12 monotherapy thereafter; extends RCT rankings and challenges default DAPT.

Cite This Study

Navarese et al. (2023) studied this question.

synapsesocial.com/papers/6a7ed717e9bb045a73c2fff5 https://doi.org/10.1093/ehjcvp/pvad016

Topics

Coronary artery disease

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Implication

Supports preferring ticagrelor monotherapy within 12 months and P2Y12 monotherapy thereafter; extends RCT rankings and challenges default DAPT.

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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