Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Clin Pharmacol Ther. 2021 Aug;110(2):424-431. doi: 10.1002/cpt.2226. Epub 2021 Mar 23.
Dual antiplatelet therapy (DAPT) and subsequent P2Y inhibitor monotherapy, particularly ticagrelor, is an emerging treatment strategy in patients undergoing percutaneous coronary intervention (PCI). This meta-analysis was designed to investigate whether short-term DAPT followed by ticagrelor monotherapy is associated with a favorable outcome as compared with standard DAPT (1-3 months of DAPT was termed "short-term" DAPT, 6-12 months DAPT was termed "standard" DAPT). The primary outcome was the composite of major adverse cardiovascular events (MACE) comprising myocardial infarction, stroke, and cardiovascular death. Secondary outcomes included all-cause mortality and net adverse clinical events (NACE; myocardial infarction, stroke, all-cause death, stent thrombosis, and major bleeding). The primary safety outcome was major bleeding. Three studies comprising 26,143 patients were included. The risk of MACE was similar between the two treatment groups (risk ratio (RR) 0.86, 95% confidence interval (CI), 0.72-1.02, P = 0.08, I = 22%). Short-term DAPT followed by ticagrelor monotherapy resulted in a 20% relative risk reduction of all-cause mortality (RR 0.80, 95% CI, 0.65-0.98, P = 0.03, I = 0%) and an 18% relative risk reduction of NACE (RR 0.82, 95% CI, 0.71-0.94, P = 0.005, I = 33%) as compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy significantly decreased the risk of major bleeding (RR 0.67, 95% CI, 0.49-0.92, P = 0.01, I = 65%). In patients with acute coronary syndrome, short-term DAPT followed by ticagrelor monotherapy resulted in an unchanged ischemic risk but a significantly lower bleeding risk compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy compared with standard DAPT resulted in a favorable safety and efficacy profile. Direct comparisons of aspirin vs. ticagrelor monotherapy following PCI are needed.
双联抗血小板治疗（DAPT）及随后的 P2Y 抑制剂单药治疗，特别是替格瑞洛，是经皮冠状动脉介入治疗（PCI）患者的一种新兴治疗策略。本荟萃分析旨在探讨与标准 DAPT（DAPT 持续 1-3 个月为“短期”，DAPT 持续 6-12 个月为“标准”）相比，短期 DAPT 后替格瑞洛单药治疗是否具有更好的结局。主要结局是主要不良心血管事件（MACE）的复合结局，包括心肌梗死、卒中和心血管死亡。次要结局包括全因死亡率和净不良临床事件（NACE；心肌梗死、卒中和全因死亡、支架血栓形成和大出血）。主要安全性结局是大出血。纳入了三项包含 26143 例患者的研究。两组治疗的 MACE 风险相似（风险比（RR）0.86，95%置信区间（CI）0.72-1.02，P=0.08，I ² =22%）。短期 DAPT 后替格瑞洛单药治疗可使全因死亡率相对风险降低 20%（RR 0.80，95%CI，0.65-0.98，P=0.03，I ² =0%），NACE 相对风险降低 18%（RR 0.82，95%CI，0.71-0.94，P=0.005，I ² =33%）。与标准 DAPT 相比，短期 DAPT 后替格瑞洛单药治疗显著降低了大出血风险（RR 0.67，95%CI，0.49-0.92，P=0.01，I ² =65%）。在急性冠状动脉综合征患者中，与标准 DAPT 相比，短期 DAPT 后替格瑞洛单药治疗并未增加缺血风险，但出血风险显著降低。与标准 DAPT 相比，短期 DAPT 后替格瑞洛单药治疗具有良好的安全性和疗效特征。需要直接比较 PCI 后阿司匹林与替格瑞洛单药治疗。
