Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention:A systematic review and network meta-analysis  

作　　者：Yuttana Wongsalap Kirati Kengkla Preyanate Wilairat Khemanat Ratworawong Surasak Saokaew Chaisiri Wanlapakorn 

机构地区：[1]Division of Clinical Pharmacy,Department of Pharmaceutical Care,University of Phayao,Phayao,Thailand [2]Center of Health Outcomes Research and Therapeutic Safety(Cohorts),School of Pharmaceutical Sciences,University of Phayao,Phayao,Thailand [3]Unit of Excellence on Clinical Outcomes Research and Integration(UNICORN),School of Pharmaceutical Sciences,University of Phayao,Phayao,Thailand [4]Division of Social and Administrative Pharmacy,Department of Pharmaceutical Care,School of Pharmaceutical Sciences,University of Phayao,Phayao,Thailand [5]Cardiac Centre,King Chulalongkorn Memorial Hospital,Krung Thep Maha Nakorn,Thailand

出　　处：《Chronic Diseases and Translational Medicine》2023年第4期299-308,共10页慢性疾病与转化医学（英文版）

基　　金：Thailand Science Research and Innovation fund;Universityof Phayao,Grant/Award Numbers:UoE66003,FF65-RIM100;Unit of Excellence on Clinical Outcomes Research and IntegratioN(UNICORN)。

摘　　要：Background:Dual antiplatelet therapy(DAPT)is key for preventing ischaemic events post-percutaneous coronary intervention(PCI).Various DAPT modifications like the shortened duration or P2Y12 inhibitor(P2Y12i)de-escalation are implemented to reduce bleeding risk.However,these strategies lack direct comparative studies.This study aimed to assess the efficacy and safety of such DAPT strategies,including de-escalated and short DAPT,in patients undergoing PCI.Methods:We searched PubMed,Embase,Cochrane Central Register of Controlled Trials,and ClinicalTrials.gov databases for relevant randomized controlled trials(RCTs).We performed a network meta-analysis(NMA)to estimate risk ratios(RRs)and 95%confidence intervals(CIs).The primary efficacy endpoint was major adverse cardiac events(MACEs),and the primary safety endpoint was major bleeding.Secondary endpoints included individual components of MACEs and net adverse clinical events(NACEs).Results:A total of 17 RCTs comprising 53,156 patients(median age,62.0 years,24.8%female)were included.NMA suggested that de-escalation DAPT was associated with a significantly lower risk of MACEs(risk ratio[RR]=0.79,95%confidence interval[CI]=0.64-0.98),bleeding(RR=0.63,95%CI=0.49-0.82),and NACEs(RR=0.69,95%CI=0.60-0.79)compared with standard DAPT.Short DAPT followed by P2Y12i monotherapy exhibited a significantly decreased risk of major bleeding(RR=0.63,95%CI=0.46-0.86)compared with standard DAPT.Conclusions:De-escalation DAPT was the most effective strategy for preventing the risk of MACEs without increasing bleeding events,while short DAPT followed by P2Y12i monotherapy was the most effective strategy for reducing the risk of bleeding among patients undergoing PCI.

关 键 词：DE-ESCALATION percutaneous coronary intervention short dual antiplatelet therapy 

分 类 号：R541.4[医药卫生—心血管疾病]