Georg Gelbenegger
Efficacy and Safety of Ticagrelor Monotherapy in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis
Gelbenegger, Georg; Schoergenhofer, Christian; Jilma, Bernd; Gager, Gloria M.; Dizdarevic, Al Medina; Mamas, Mamas A.; Parapid, Biljana; Velagapudi, Poonam; Siller‐Matula, Jolanta M.
Authors
Christian Schoergenhofer
Bernd Jilma
Gloria M. Gager
Al Medina Dizdarevic
Mamas Mamas m.mamas@keele.ac.uk
Biljana Parapid
Poonam Velagapudi
Jolanta M. Siller‐Matula
Abstract
Dual antiplatelet therapy (DAPT) and subsequent P2Y12 inhibitor monotherapy, particularly ticagrelor, is an emerging treatment strategy in patients undergoing percutaneous coronary intervention (PCI). This meta-analysis was designed to investigate whether short-term DAPT followed by ticagrelor monotherapy is associated with a favorable outcome as compared with standard DAPT (1–3 months of DAPT was termed “short-term” DAPT, 6–12 months DAPT was termed “standard” DAPT). The primary outcome was the composite of major adverse cardiovascular events (MACE) comprising myocardial infarction, stroke, and cardiovascular death. Secondary outcomes included all-cause mortality and net adverse clinical events (NACE; myocardial infarction, stroke, all-cause death, stent thrombosis, and major bleeding). The primary safety outcome was major bleeding. Three studies comprising 26,143 patients were included. The risk of MACE was similar between the two treatment groups (risk ratio (RR) 0.86, 95% confidence interval (CI), 0.72–1.02, P = 0.08, I2 = 22%). Short-term DAPT followed by ticagrelor monotherapy resulted in a 20% relative risk reduction of all-cause mortality (RR 0.80, 95% CI, 0.65–0.98, P = 0.03, I2 = 0%) and an 18% relative risk reduction of NACE (RR 0.82, 95% CI, 0.71–0.94, P = 0.005, I2 = 33%) as compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy significantly decreased the risk of major bleeding (RR 0.67, 95% CI, 0.49–0.92, P = 0.01, I2 = 65%). In patients with acute coronary syndrome, short-term DAPT followed by ticagrelor monotherapy resulted in an unchanged ischemic risk but a significantly lower bleeding risk compared with standard DAPT. Short-term DAPT followed by ticagrelor monotherapy compared with standard DAPT resulted in a favorable safety and efficacy profile. Direct comparisons of aspirin vs. ticagrelor monotherapy following PCI are needed.
Journal Article Type | Article |
---|---|
Acceptance Date | Feb 23, 2021 |
Online Publication Date | Mar 23, 2021 |
Publication Date | Mar 5, 2021 |
Journal | Clinical Pharmacology and Therapeutics |
Print ISSN | 0009-9236 |
Publisher | American Society for Clinical Pharmacology and Therapeutics |
Volume | 110 |
Issue | 2 |
Pages | 424-431 |
DOI | https://doi.org/10.1002/cpt.2226 |
Keywords | Pharmacology (medical), Pharmacology |
Publisher URL | https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.2226 |
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https://creativecommons.org/licenses/by-nc/4.0/
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