De-escalation of antiplatelet therapy after percutaneous coronary intervention among East Asians and non-East Asians: a meta-analysis of randomized controlled trials.
BMC Cardiovasc Disord
; 22(1): 29, 2022 02 04.
Article
em En
| MEDLINE
| ID: mdl-35120454
ABSTRACT
BACKGROUND:
To study the impact of de-escalation antiplatelet therapy retaining P2Y12 inhibition on major bleeding and ischemic outcomes after percutaneous coronary intervention (PCI) among East Asians and non-East Asians was unclear.METHODS:
We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials through September 2020. Eight trials were included, which studied de-escalation of DAPT (D-DAPT, switching to P2Y12 inhibitor monotherapy, or switching to clopidogrel or dose reduction of the P2Y12 inhibitor after 1 to 3 months) versus 12 months standard DAPT (S-DAPT). The primary outcomes data was conducted using random effects models.RESULTS:
Among the 8 included trials consisting of 37,775 patients, 62.6% presented with acute coronary syndrome. The median follow-up duration ranged from 12 to 24 months. Compared with S-DAPT, D-DAPT was associated with a lower risk of major bleeding (RR = 0.67, 95% CI 0.48-0.93, p = 0.02); however, this was only observed among East-Asians (RR = 0.61, 95% CI 0.37-0.99, p = 0.048). Among non-East Asians, the rate of major bleeding was similar between the two groups (RR = 0.73, 95% CI 0.46-1.14, p = 0.17, p for interaction = 0.59). There were no significant differences in the major adverse cardiovascular events (MACE) between D-DAPT and S-DAPT treatment among both East Asians (RR = 0.84, 95% CI 0.66-1.08, p = 0.18) and non-East Asians (RR = 0.89, 95% CI 0.79-1.00, p = 0.059, p for interaction = 0.71).CONCLUSIONS:
The De-escalation strategy that retains P2Y12 inhibition after a PCI was associated with reduced risk of bleeding events, which was only demonstrated in East Asians patients, and not in non-East Asian patients.Palavras-chave
Texto completo:
1
Eixos temáticos:
Pesquisa_clinica
Base de dados:
MEDLINE
Assunto principal:
Inibidores da Agregação Plaquetária
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Ensaios Clínicos Controlados Aleatórios como Assunto
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Povo Asiático
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Stents Farmacológicos
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Intervenção Coronária Percutânea
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Infarto do Miocárdio
Tipo de estudo:
Clinical_trials
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Incidence_studies
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Prognostic_studies
/
Systematic_reviews
Limite:
Humans
País como assunto:
Asia
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article