Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials

Lin, Yaowang1,2; Cai, Zhigang3; Dong, Shaohong1,2; Liu, Huadong1,2; Pang, Xinli1,2; Chen, Qiuling4; Yuan, Jie1,2; Geng, Qingshan1,2,5

2022-09-30

10.3389/fphar.2022.992376

FRONTIERS IN PHARMACOLOGY   Impact Factor & Quartile

1663-9812

Aimed to evaluate and compare the interactive effects of different antiplatelet or anticoagulation strategies in patients with chronic coronary syndromes (CCS) after percutaneous coronary intervention (PCI). Randomized controlled trials comparing different antiplatelet or anticoagulant strategies in patients with CCS after PCI were included. The primary outcomes were major adverse cardiovascular event (MACE), mortality, ischemic and bleeding events. Compared to aspirin alone, addition of prasugrel or ticagrelor to aspirin resulted in lower risk of myocardial infarction (MI) [odds ratio (OR): 0.38 (95% confidence interval 0.38-0.62); 0.810-0.84 (0.69-0.98)] and any stroke [0.56 (0.42-0.75)] at the expense of increased risk of major bleeding [1.79 (1.34-2.39); 2.08-2.38 (1.56-3.28)], whereas, clopidogrel monotherapy reduced the risk of any stroke, major bleeding, and intracranial bleeding. On subgroup analysis, compared with aspirin alone, addition of prasugrel resulted in lower MACE [0.72 (0.60-0.86)], MI [0.48 (0.38-0.62)], and stent thrombosis [0.29 (0.09-0.91)], whereas, addition of rivaroxaban 2.5 mg resulted in lower risk of MACE [0.72 (0.60-0.87)], cardiac death [0.71 (0.52-0.98)] and any stroke [0.65 (0.45-0.95)], but not reduced MI. Both prasugrel and rivaroxaban 2.5 mg increased major bleeding [1.79 (1.34-2.39); 1.72 (1.33-2.22)]. Clopidogrel monotherapy was associated with lower MACE [0.72 (0.58-0.90)], any stroke [0.42 (0.24-0.73)], and major bleeding [0.62 (0.40-0.96)]. Adding prasugrel or ticagrelor led to a reduced incidence of MI and prasugrel was also found to reduce the risk of MACE and stent thrombosis in CCS patients with low risk of bleeding after PCI. Clopidogrel monotherapy has advantage in reducing MACE, stroke, and major bleeding events in CCS patients at high risk of bleeding after PCI.

antiplatelet therapy chronic coronary syndromes percutaneous coronary intervention randomized control trials geriatric disease anticoagulant

SCI

English

Corresponding

[JCYJ20210324113614038] ; [SZXK003] ; [SZXK059] ; [SZSM201412012]

Pharmacology & Pharmacy

Pharmacology & Pharmacy

WOS:000868662500001

FRONTIERS MEDIA SA

Web of Science

1.Jinan Univ, Shenzhen Peoples Hosp, Dept Cardiol, Clin Med Coll 2, Shenzhen, Guangdong, Peoples R China
2.Southern Univ Sci & Technol, Affiliated Hosp 1, Cardiovasc Minimally Invas Med Engn Technol Res &, Shenzhen Key Med Disciplin SZXK003, Shenzhen, Guangdong, Peoples R China
3.Guangzhou Univ Chinese Med Futian, Inst Shenzhen Hosp, Shenzhen, Peoples R China
4.Shenzhen Peoples Hosp, Dept Pharm, Shenzhen, Guangdong, Peoples R China
5.Shenzhen Peoples Hosp, Dept Geriatr, Shenzhen, Guangdong, Peoples R China

Lin, Yaowang,Cai, Zhigang,Dong, Shaohong,et al. Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials[J]. FRONTIERS IN PHARMACOLOGY,2022,13.

Lin, Yaowang.,Cai, Zhigang.,Dong, Shaohong.,Liu, Huadong.,Pang, Xinli.,...&Geng, Qingshan.(2022).Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials.FRONTIERS IN PHARMACOLOGY,13.

Lin, Yaowang,et al."Comparative efficacy and safety of antiplatelet or anticoagulant therapy in patients with chronic coronary syndromes after percutaneous coronary intervention: A network meta-analysis of randomized controlled trials".FRONTIERS IN PHARMACOLOGY 13(2022).