Efficacy and safety of ticagrelor monotherapy following a brief DAPT vs. prolonged 12-month DAPT in ACS patients post-PCI: a meta-analysis of RCTs

Background As per current guidelines, acute coronary syndrome (ACS) patients who undergo percutaneous coronary intervention (PCI) should be started on dual antiplatelet therapy (DAPT) for a period of 12 months. Objective To assess the efficacy and safety of brief DAPT (up to 3 months) succeeded by t...

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Bibliographic Details
Published in:	European journal of clinical pharmacology Vol. 80; no. 12; pp. 1871 - 1882
Main Authors:	Qamar, Usama, Naeem, Farhan, Maqsood, Muhammad Talha, Khan, Maleeka Zamurad, Imtiaz, Zeeshan, Saeed, Fatima, Gupta, Neelesh, Brohi, Fnu Zafarullah, Mkpozi, Celestine, Sattar, Yasar
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2024 Springer Nature B.V
Subjects:	Acute coronary syndromes Antiplatelet therapy Biomedical and Life Sciences Biomedicine Bleeding Clinical trials Pharmacology/Toxicology Review ACS Ticagrelor Monotherapy DAPT Bleeding PCI
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Summary:	Background As per current guidelines, acute coronary syndrome (ACS) patients who undergo percutaneous coronary intervention (PCI) should be started on dual antiplatelet therapy (DAPT) for a period of 12 months. Objective To assess the efficacy and safety of brief DAPT (up to 3 months) succeeded by ticagrelor monotherapy compared with a 12-month DAPT in ACS patients following PCI. Methods We systematically searched Cochrane, Embase, and PubMed to find relevant randomized clinical trials. Examined outcomes included the incidence of major adverse cerebrovascular and cardiovascular events (MACCE), bleeding events, and the composite incidence of net adverse clinical events (NACE). Results Our primary analysis included 21,927 ACS patients from six RCTs. Our pooled results indicate that following PCI in individuals with ACS, brief DAPT followed by ticagrelor did not increase the risk of MACCE (OR 0.92, 95% CI 0.79–1.07) but significantly reduced the risk of minor or major bleeding (OR 0.52, 95% CI 0.44–0.62) and NACE (OR 0.71, 95% CI 0.59–0.86) compared with a long-term DAPT within a follow-up of 12 months. Conclusion Brief DAPT followed by ticagrelor monotherapy is superior to a 12-month DAPT in offering a net clinical advantage in ACS patients following PCI.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-4 content type line 23 ObjectType-Undefined-3
ISSN:	0031-6970 1432-1041 1432-1041
DOI:	10.1007/s00228-024-03747-w