P2Y12 inhibitor monotherapy reduced major bleedings by 35% (HR 0.65) compared to dual antiplatelet therapy in patients undergoing percutaneous coronary intervention, regardless of baseline bleeding risk.
Meta-Analysis (n=30,084)
Yes
Does P2Y12 inhibitor monotherapy after a short period of DAPT reduce major bleedings, MACCE, and NACE compared to standard DAPT in patients undergoing PCI?
P2Y12 inhibitor monotherapy after a short period of DAPT reduces major bleeding without increasing ischemic events compared to standard DAPT after PCI, regardless of baseline bleeding risk.
Effect estimate: HR 0.65 (95% CI 0.44 to 0.92)
BACKGROUND: P2Y12 inhibitor monotherapy is a promising novel strategy to reduce bleeding complications compared to dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI). In order to personalise treatment with DAPT based on patients' bleeding risk, we compared outcomes after PCI between P2Y12 inhibitor monotherapy and DAPT according to bleeding risk. METHODS: A search for randomized clinical trials (RCTs) comparing P2Y12 inhibitor monotherapy after a short period of DAPT to standard DAPT after PCI was performed. Outcome differences between treatment groups regarding major bleedings, major adverse cardiac and cerebral events (MACCE) and net adverse clinical events (NACE) were assessed with hazard ratios (HRs) and corresponding credible intervals (CrI) according a Bayesian random effects model in patients with and without high bleeding risk (HBR). RESULTS: Five RCTs including 30,084 patients were selected. P2Y12 inhibitor monotherapy compared to DAPT reduced major bleedings in the total population (HR: 0.65, 95 % CrI: 0.44 to 0.92). The HRs of the HBR and non-HBR subgroups showed a similar reduction of bleedings for monotherapy (HBR: HR 0.66, 95 % CrI: 0.25 to 1.74; non-HBR: HR 0.63, 95 % CrI: 0.36 to 1.09). No notable differences between treatments on MACCE and NACE were observed in either sub-group or in the total population. CONCLUSIONS: Regardless of bleeding risk, P2Y12 inhibitor monotherapy is the favourable choice after PCI regarding major bleedings and does not increase ischemic events compared to DAPT. This suggests that bleeding risk is not decisive when considering P2Y12 inhibitor monotherapy.
Woelders et al. (Mon,) conducted a meta-analysis in Percutaneous coronary intervention (PCI) (n=30,084). P2Y12 inhibitor monotherapy vs. Dual antiplatelet therapy (DAPT) was evaluated on Major bleeding events (HR 0.65, 95% CI 0.44 to 0.92). P2Y12 inhibitor monotherapy reduced major bleedings by 35% (HR 0.65) compared to dual antiplatelet therapy in patients undergoing percutaneous coronary intervention, regardless of baseline bleeding risk.