Navarese Eliano Pio, Landi Antonio, Oliva Angelo, Piccolo Raffaele, Aboyans Victor, Angiolillo Dominick, Atar Dan, Capodanno Davide, Fox Keith A A, Halvorsen Sigrun, James Stefan, Jüni Peter, Kunadian Vijay, Leonardi Sergio, Mehran Roxana, Montalescot Gilles, Niebauer Josef, Price Susanna, Storey Robert F, Völler Heinz, Vranckx Pascal, Windecker Stephan, Valgimigli Marco
Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.
SIRIO MEDICINE Research Network, Poland.
Eur Heart J Cardiovasc Pharmacother. 2023 Apr 10;9(3):271-290. doi: 10.1093/ehjcvp/pvad016.
To appraise all available antithrombotic treatments within or after 12 months following coronary revascularization and/or acute coronary syndrome in two network meta-analyses.
Forty-three (N = 189 261 patients) trials within 12 months and 19 (N = 139 086 patients) trials beyond 12 months were included for efficacy/safety endpoints appraisal. Within 12 months, ticagrelor 90 mg bis in die (b.i.d.) [hazard ratio (HR), 0.66; 95% confidence interval (CI), 0.49-0.88], aspirin and ticagrelor 90 mg (HR, 0.85; 95% CI, 0.76-0.95), or aspirin, clopidogrel and rivaroxaban 2.5 mg b.i.d. (HR, 0.66; 95% CI, 0.51-0.86) were the only treatments associated with lower cardiovascular mortality, compared with aspirin and clopidogrel, without or with greater bleeding risk for the first and the other treatment options, respectively. Beyond 12 months, no strategy lowered mortality; compared with aspirin; the greatest reductions of myocardial infarction (MI) were found with aspirin and clopidogrel (HR, 0.68; 95% CI, 0.55-0.85) or P2Y12 inhibitor monotherapy (HR, 0.76; 95% CI: 0.61-0.95), especially ticagrelor 90 mg (HR, 0.54; 95% CI, 0.32-0.92), and of stroke with VKA (HR, 0.56; 95% CI, 0.44-0.76) or aspirin and rivaroxaban 2.5 mg (HR, 0.58; 95% CI, 0.44-0.76). All treatments increased bleeding except P2Y12 monotherapy, compared with aspirin.
Within 12 months, ticagrelor 90 mg monotherapy was the only treatment associated with lower mortality, without bleeding risk trade-off compared with aspirin and clopidogrel. Beyond 12 months, P2Y12 monotherapy, especially ticagrelor 90 mg, was associated with lower MI without bleeding trade-off; aspirin and rivaroxaban 2.5 mg most effectively reduced stroke, with a more acceptable bleeding risk than VKA, compared with aspirin.Registration URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifiers: CRD42021243985 and CRD42021252398.
在两项网状荟萃分析中评估冠状动脉血运重建和/或急性冠状动脉综合征后12个月内或之后的所有可用抗血栓治疗。
纳入43项（N = 189261例患者）12个月内的试验和19项（N = 139086例患者）12个月后的试验，用于疗效/安全性终点评估。在12个月内，与阿司匹林和氯吡格雷相比，替格瑞洛90毫克每日两次（b.i.d.）[风险比（HR），0.66；95%置信区间（CI），0.49 - 0.88]、阿司匹林和替格瑞洛90毫克（HR，0.85；95% CI，0.76 - 0.95）或阿司匹林、氯吡格雷和利伐沙班2.5毫克b.i.d.（HR，0.66；95% CI，0.51 - 0.86）是仅有的与较低心血管死亡率相关的治疗方法，第一种和其他治疗方案分别没有或有更高的出血风险。在12个月后，没有策略能降低死亡率；与阿司匹林相比，阿司匹林和氯吡格雷（HR，0.68；95% CI，0.55 - 0.85）或P2Y12抑制剂单药治疗（HR，0.76；95% CI：0.61 - 0.95），尤其是替格瑞洛90毫克（HR，0.54；95% CI，0.32 - 0.92），对心肌梗死（MI）的降低幅度最大，而维生素K拮抗剂（VKA）（HR，0.56；95% CI，0.44 - 0.76）或阿司匹林和利伐沙班2.5毫克（HR，0.58；95% CI，0.44 - 0.76）对中风的降低幅度最大。与阿司匹林相比，除P2Y12单药治疗外，所有治疗均增加出血风险。
在12个月内，替格瑞洛90毫克单药治疗是唯一与较低死亡率相关的治疗方法，与阿司匹林和氯吡格雷相比无出血风险权衡。在12个月后，P2Y12单药治疗，尤其是替格瑞洛90毫克，与较低的MI相关且无出血权衡；与阿司匹林相比，阿司匹林和利伐沙班2.5毫克最有效地降低了中风风险，且出血风险比VKA更可接受。
https://www.crd.york.ac.uk/PROSPERO/；唯一标识符：CRD42021243985和CRD42021252398 。
