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Listen "De-escalation of Antiplatelet Therapy After Percutaneous Coronary Intervention in East Asian Patients With Acute Coronary Syndrome"
Episode Synopsis
De-escalation of Antiplatelet Therapy After Percutaneous Coronary Intervention in East Asian Patients With Acute
Coronary Syndrome
Clin Ther. 2023 Dec 8:S0149-2918(23)00305-3.
doi: 10.1016/j.clinthera.2023.08.004
Abstract
Purpose: East Asian individuals have a lower risk of thromboembolic events while potentially carrying a higher risk
of bleeding events compared with non-Asian individuals. The aim of the present analysis was to investigate the effectiveness and safety of the de-escalation of antiplatelet therapy compared with standard dual antiplatelet therapy (DAPT)
in East Asian patients undergoing percutaneous coronary intervention (PCI).
Methods: Randomized controlled trials comparing de-escalation with DAPT in patients with acute coronary
syndrome (ACS) were retrieved from electronic databases from their inception until March 2022. Outcomes included major adverse cardiovascular events (MACE), ischemic events, major bleeding, minor bleeding, and any bleeding. Subgroup
analyses based on treatment strategy were conducted. Statistical analysis was performed by using Review Manager version 5.4.
Findings: Eight randomized controlled trials from 539 potentially relevant publications with a total of 15,744 East Asian patients were included. Pooled data from these studies found
a significantly lower MACE (0.82; 95% CI, 0.69-0.98) and major bleeding event (0.62; 95% CI, 0.46-0.82) in de-escalation than standard-DAPT without heterogeneity. Subgroup analysis was divided into DAPT followed by P2Y12 inhibitor monotherapy and a reducing dose of P2Y12 inhibitors. DAPT followed by
P2Y12 inhibitor monotherapy had a 48% lower incidence of major bleeding events than standard DAPT (0.52; 95% CI, 0.27-1.00); there was no significant difference in major bleeding (0.99; 95% CI, 0.55-1.76) between the reducing
dose of P2Y12 inhibitors and standard DAPT.
Implications: De-escalation is a promising and potentially optimal antiplatelet therapy for patients from East
Asia with PCI. DAPT followed by P2Y12 inhibitor monotherapy might be a safer and equally effective approach compared with standard DAPT in East Asian patients with PCI.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
Coronary Syndrome
Clin Ther. 2023 Dec 8:S0149-2918(23)00305-3.
doi: 10.1016/j.clinthera.2023.08.004
Abstract
Purpose: East Asian individuals have a lower risk of thromboembolic events while potentially carrying a higher risk
of bleeding events compared with non-Asian individuals. The aim of the present analysis was to investigate the effectiveness and safety of the de-escalation of antiplatelet therapy compared with standard dual antiplatelet therapy (DAPT)
in East Asian patients undergoing percutaneous coronary intervention (PCI).
Methods: Randomized controlled trials comparing de-escalation with DAPT in patients with acute coronary
syndrome (ACS) were retrieved from electronic databases from their inception until March 2022. Outcomes included major adverse cardiovascular events (MACE), ischemic events, major bleeding, minor bleeding, and any bleeding. Subgroup
analyses based on treatment strategy were conducted. Statistical analysis was performed by using Review Manager version 5.4.
Findings: Eight randomized controlled trials from 539 potentially relevant publications with a total of 15,744 East Asian patients were included. Pooled data from these studies found
a significantly lower MACE (0.82; 95% CI, 0.69-0.98) and major bleeding event (0.62; 95% CI, 0.46-0.82) in de-escalation than standard-DAPT without heterogeneity. Subgroup analysis was divided into DAPT followed by P2Y12 inhibitor monotherapy and a reducing dose of P2Y12 inhibitors. DAPT followed by
P2Y12 inhibitor monotherapy had a 48% lower incidence of major bleeding events than standard DAPT (0.52; 95% CI, 0.27-1.00); there was no significant difference in major bleeding (0.99; 95% CI, 0.55-1.76) between the reducing
dose of P2Y12 inhibitors and standard DAPT.
Implications: De-escalation is a promising and potentially optimal antiplatelet therapy for patients from East
Asia with PCI. DAPT followed by P2Y12 inhibitor monotherapy might be a safer and equally effective approach compared with standard DAPT in East Asian patients with PCI.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
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