Al-Zahraa College of Medicine/University of Basrah, Basrah, Iraq | Basra Cardiac Centre, Basrah, Iraq.
Patient and Population Health and Informatics Research, Swansea University Medical School, Swansea University, Swansea, UK.
Curr Cardiol Rev. 2021;17(6):e051121190712. doi: 10.2174/1573403X17666210126104053.
The optimal duration of dual antiplatelet therapy is a matter of ongoing research. Clinical studies are assessing the optimal duration with the most favourable risk to benefit ratio. The efficacy of P2Y12 receptor inhibitors comparable to aspirin in preventing recurrent ischaemic events in patients with coronary artery diseases.
To investigate the outcomes of short-duration dual antiplatelet therapy after PCI with early discontinuation of aspirin while maintaining patients on P2Y12 inhibitor through systematic review and meta-analysis of available literature.
We systematically searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. We included randomized controlled studies that measured clinical outcomes of efficacy (mortality and ischaemic events) and safety (bleeding) of short and standard-duration dual antiplatelet therapy. The protocol of this study was registered in the international prospective register of systematic reviews PROSPERO registry (CRD42020171468).
Four randomized controlled trials were included; GLOBAL LEADERS, SMARTCHOICE, STOPDAPT-2, and TWILIGHT. The total number of patients was 29,089. The safety outcomes showed a significant reduction in major bleeding events with short-duration dual antiplatelet therapy; the risk ratio was 0.61 (95% CI 0.38-0.99; z=2,00, p=0.05). There was no difference between short and standard-duration dual antiplatelet therapy regarding efficacy outcomes (all- cause death, major adverse cardiovascular events, myocardial infarction, stroke, and stent thrombosis).
Short-duration dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy after PCI is a feasible option and can be adopted, especially in patients with a high risk of bleeding.
双联抗血小板治疗的最佳持续时间是一个正在研究的问题。临床研究正在评估最佳持续时间和最有利的风险效益比。与阿司匹林相比，P2Y12 受体抑制剂在预防冠心病患者复发性缺血事件方面具有疗效。
通过对现有文献的系统评价和荟萃分析，调查 PCI 后短期双联抗血小板治疗（提前停用阿司匹林，同时维持患者使用 P2Y12 抑制剂）的结果。
我们系统地检索了 PubMed、Cochrane 中心对照试验注册库（CENTRAL）和 ClinicalTrials.gov。我们纳入了测量短期和标准双联抗血小板治疗疗效（死亡率和缺血事件）和安全性（出血）的随机对照研究。本研究的方案已在国际前瞻性系统评价注册库 PROSPERO 注册（CRD42020171468）。
共纳入了 4 项随机对照试验，即 GLOBAL LEADERS、SMARTCHOICE、STOPDAPT-2 和 TWILIGHT。总共有 29089 名患者。安全性结果显示，短期双联抗血小板治疗可显著减少大出血事件；风险比为 0.61（95%CI 0.38-0.99；z=2，p=0.05）。短期和标准双联抗血小板治疗在疗效结果方面（全因死亡、主要不良心血管事件、心肌梗死、卒中和支架血栓形成）无差异。
PCI 后短期双联抗血小板治疗后再行 P2Y12 抑制剂单药治疗是一种可行的选择，尤其是在出血风险较高的患者中。
