Outcomes with P2Y12 inhibitor monotherapy after PCI according to bleeding risk: A Bayesian meta-analysis
P2Y12 inhibitor monotherapy is a promising novel strategy to reduce bleeding complications compared to dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI). In order to personalise treatment with DAPT based on patients' bleeding risk, we compared outc...
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| Published in: | Cardiovascular revascularization medicine Vol. 55; pp. 44 - 51 |
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| Main Authors: | , , , , , , , , , |
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01-10-2023
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| Abstract | P2Y12 inhibitor monotherapy is a promising novel strategy to reduce bleeding complications compared to dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI). In order to personalise treatment with DAPT based on patients' bleeding risk, we compared outcomes after PCI between P2Y12 inhibitor monotherapy and DAPT according to bleeding risk.
A search for randomized clinical trials (RCTs) comparing P2Y12 inhibitor monotherapy after a short period of DAPT to standard DAPT after PCI was performed. Outcome differences between treatment groups regarding major bleedings, major adverse cardiac and cerebral events (MACCE) and net adverse clinical events (NACE) were assessed with hazard ratios (HRs) and corresponding credible intervals (CrI) according a Bayesian random effects model in patients with and without high bleeding risk (HBR).
Five RCTs including 30,084 patients were selected. P2Y12 inhibitor monotherapy compared to DAPT reduced major bleedings in the total population (HR: 0.65, 95 % CrI: 0.44 to 0.92). The HRs of the HBR and non-HBR subgroups showed a similar reduction of bleedings for monotherapy (HBR: HR 0.66, 95 % CrI: 0.25 to 1.74; non-HBR: HR 0.63, 95 % CrI: 0.36 to 1.09). No notable differences between treatments on MACCE and NACE were observed in either sub-group or in the total population.
Regardless of bleeding risk, P2Y12 inhibitor monotherapy is the favourable choice after PCI regarding major bleedings and does not increase ischemic events compared to DAPT. This suggests that bleeding risk is not decisive when considering P2Y12 inhibitor monotherapy.
•Bleeding risk should not be decisive when considering P2Y12 inhibitor monotherapy.•P2Y12 inhibitor monotherapy could be a potential default strategy after PCI.•Thromboembolic- and bleeding complications are more common in patients with HBR. |
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| AbstractList | P2Y12 inhibitor monotherapy is a promising novel strategy to reduce bleeding complications compared to dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI). In order to personalise treatment with DAPT based on patients' bleeding risk, we compared outcomes after PCI between P2Y12 inhibitor monotherapy and DAPT according to bleeding risk.
A search for randomized clinical trials (RCTs) comparing P2Y12 inhibitor monotherapy after a short period of DAPT to standard DAPT after PCI was performed. Outcome differences between treatment groups regarding major bleedings, major adverse cardiac and cerebral events (MACCE) and net adverse clinical events (NACE) were assessed with hazard ratios (HRs) and corresponding credible intervals (CrI) according a Bayesian random effects model in patients with and without high bleeding risk (HBR).
Five RCTs including 30,084 patients were selected. P2Y12 inhibitor monotherapy compared to DAPT reduced major bleedings in the total population (HR: 0.65, 95 % CrI: 0.44 to 0.92). The HRs of the HBR and non-HBR subgroups showed a similar reduction of bleedings for monotherapy (HBR: HR 0.66, 95 % CrI: 0.25 to 1.74; non-HBR: HR 0.63, 95 % CrI: 0.36 to 1.09). No notable differences between treatments on MACCE and NACE were observed in either sub-group or in the total population.
Regardless of bleeding risk, P2Y12 inhibitor monotherapy is the favourable choice after PCI regarding major bleedings and does not increase ischemic events compared to DAPT. This suggests that bleeding risk is not decisive when considering P2Y12 inhibitor monotherapy. BACKGROUNDP2Y12 inhibitor monotherapy is a promising novel strategy to reduce bleeding complications compared to dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI). In order to personalise treatment with DAPT based on patients' bleeding risk, we compared outcomes after PCI between P2Y12 inhibitor monotherapy and DAPT according to bleeding risk.METHODSA search for randomized clinical trials (RCTs) comparing P2Y12 inhibitor monotherapy after a short period of DAPT to standard DAPT after PCI was performed. Outcome differences between treatment groups regarding major bleedings, major adverse cardiac and cerebral events (MACCE) and net adverse clinical events (NACE) were assessed with hazard ratios (HRs) and corresponding credible intervals (CrI) according a Bayesian random effects model in patients with and without high bleeding risk (HBR).RESULTSFive RCTs including 30,084 patients were selected. P2Y12 inhibitor monotherapy compared to DAPT reduced major bleedings in the total population (HR: 0.65, 95 % CrI: 0.44 to 0.92). The HRs of the HBR and non-HBR subgroups showed a similar reduction of bleedings for monotherapy (HBR: HR 0.66, 95 % CrI: 0.25 to 1.74; non-HBR: HR 0.63, 95 % CrI: 0.36 to 1.09). No notable differences between treatments on MACCE and NACE were observed in either sub-group or in the total population.CONCLUSIONSRegardless of bleeding risk, P2Y12 inhibitor monotherapy is the favourable choice after PCI regarding major bleedings and does not increase ischemic events compared to DAPT. This suggests that bleeding risk is not decisive when considering P2Y12 inhibitor monotherapy. P2Y12 inhibitor monotherapy is a promising novel strategy to reduce bleeding complications compared to dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI). In order to personalise treatment with DAPT based on patients' bleeding risk, we compared outcomes after PCI between P2Y12 inhibitor monotherapy and DAPT according to bleeding risk. A search for randomized clinical trials (RCTs) comparing P2Y12 inhibitor monotherapy after a short period of DAPT to standard DAPT after PCI was performed. Outcome differences between treatment groups regarding major bleedings, major adverse cardiac and cerebral events (MACCE) and net adverse clinical events (NACE) were assessed with hazard ratios (HRs) and corresponding credible intervals (CrI) according a Bayesian random effects model in patients with and without high bleeding risk (HBR). Five RCTs including 30,084 patients were selected. P2Y12 inhibitor monotherapy compared to DAPT reduced major bleedings in the total population (HR: 0.65, 95 % CrI: 0.44 to 0.92). The HRs of the HBR and non-HBR subgroups showed a similar reduction of bleedings for monotherapy (HBR: HR 0.66, 95 % CrI: 0.25 to 1.74; non-HBR: HR 0.63, 95 % CrI: 0.36 to 1.09). No notable differences between treatments on MACCE and NACE were observed in either sub-group or in the total population. Regardless of bleeding risk, P2Y12 inhibitor monotherapy is the favourable choice after PCI regarding major bleedings and does not increase ischemic events compared to DAPT. This suggests that bleeding risk is not decisive when considering P2Y12 inhibitor monotherapy. •Bleeding risk should not be decisive when considering P2Y12 inhibitor monotherapy.•P2Y12 inhibitor monotherapy could be a potential default strategy after PCI.•Thromboembolic- and bleeding complications are more common in patients with HBR. |
| Author | Winkler, Patty J.C. Hof, Arnoud W.J. van't Dimitriu-Leen, Aukelien C. Smits, Pieter C. van Geuns, Robert Jan M. Damman, Peter Rodwell, Laura Luijkx, Jasper J.P. van Royen, Niels Woelders, Eva C.I. |
| Author_xml | – sequence: 1 givenname: Eva C.I. surname: Woelders fullname: Woelders, Eva C.I. organization: Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands – sequence: 2 givenname: Jasper J.P. surname: Luijkx fullname: Luijkx, Jasper J.P. organization: Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands – sequence: 3 givenname: Laura surname: Rodwell fullname: Rodwell, Laura organization: Radboud Institute for Health Sciences, Health Evidence, Section Biostatistics, Nijmegen, the Netherlands – sequence: 4 givenname: Patty J.C. surname: Winkler fullname: Winkler, Patty J.C. organization: Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands – sequence: 5 givenname: Aukelien C. surname: Dimitriu-Leen fullname: Dimitriu-Leen, Aukelien C. organization: Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands – sequence: 6 givenname: Pieter C. surname: Smits fullname: Smits, Pieter C. organization: Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands – sequence: 7 givenname: Niels surname: van Royen fullname: van Royen, Niels organization: Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands – sequence: 8 givenname: Arnoud W.J. van't surname: Hof fullname: Hof, Arnoud W.J. van't organization: Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands – sequence: 9 givenname: Peter surname: Damman fullname: Damman, Peter organization: Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands – sequence: 10 givenname: Robert Jan M. surname: van Geuns fullname: van Geuns, Robert Jan M. email: robertjan.vangeuns@radboudumc.nl organization: Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37188619$$D View this record in MEDLINE/PubMed |
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| Keywords | P2Y12 inhibitor Bleeding risk |
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