Increased bleeding events with the addition of apixaban to the dual anti-platelet regimen for the treatment of patients with acute coronary syndrome

Abstract

Background: Dual anti-platelet therapy (DAPT) with aspirin and clopidogrel has been the mainstay of treatment for patients with acute coronary syndrome (ACS). However, the recurrence of thrombotic events, potential aspirin and clopidogrel hypo-responsiveness, and other limitations of DAPT have led to the development of newer oral anti-thrombotic drugs. Apixaban, a new non-vitamin K antagonist, has been approved for use. In this meta-analysis, we aimed to compare the bleeding outcomes observed with the addition of apixaban to DAPT for the treatment of patients with ACS. Methods: Online databases including EMBASE, Cochrane Central, http://www.ClinicalTrials.gov , MEDLINE and Web of Science were searched for English based publications comparing the use of apixaban added to DAPT for the treatment of patients with ACS. Different categories of bleeding events and cardiovascular outcomes were assessed. The analysis was carried out by the RevMan software version 5.4. Odds ratios (OR) with 95% confidence intervals (CI) were used to represent the data following analysis. Results: This research analysis consisted of 4 trials with a total number of 9010 participants. Thrombolysis in myocardial infarction (TIMI) defined major bleeding (OR: 2.45, 95% CI: 1.45–4.12; P = .0008), TIMI defined minor bleeding (OR: 3.12, 95% CI: 1.71–5.70; P = .0002), International society of thrombosis and hemostasis (ISTH) major bleeding (OR: 2.49, 95% CI: 1.80–3.45; P = .00001) and Global Use of Strategies to Open Occluded Arteries (GUSTO) defined severe bleeding (OR: 3.00, 95% CI: 1.56–5.78; P = .01) were significantly increased with the addition of apixaban to DAPT versus DAPT alone in these patients with ACS. However fatal bleeding (OR: 10.96, 95% CI: 0.61–198.3; P = .11) was not significantly different. Conclusions: Addition of the novel oral anticoagulant apixaban to the DAPT regimen significantly increased bleeding and therefore did not show any beneficial effect in these patients with ACS. However, due to the extremely limited data, we apparently have to rely on future larger studies to confirm this hypothesis.

The Diagnostic Value of Combined Detection of Serum Lp-PLA2 and Hcy and Color Doppler in Elderly Patients with Acute Coronary Syndrome and Effect on Endothelial Function

“…Carotid ultrasonography provides a comprehensive analysis of ACS in the elderly. Ultrasonography has high sensitivity and specificity through the enhancement of scattered echoes by the use of contrast agents, which enhances ultrasound diagnostic discrimination [1]. LP-PLA2 is a key indicator in the study of clinical vascular disease and an independent risk factor for cardiovascular disease mostly used to study inflammatory response mediators [2].…”

“…Acute coronary syndrome (ACS) refers to a series of acute symptoms caused by changes in the position of plaques in the coronary arteries that a ect the ow of blood in the arteries. Such symptoms can cause acute myocardial ischemia, myocardial infarction, angina, and thrombus [1][2][3].…”

Palmatine Derivatives as Potential Antiplatelet Aggregation Agents via Protein Kinase G/Vasodilator-Stimulated Phosphoprotein and Phosphatidylinositol 3-Kinase/Akt Phosphorylation

“…The abnormal activation, adhesion, and aggregation of platelets may induce thrombus formation and cause obstructive cardiovascular or cerebrovascular diseases, which result in the higher mortality or morbidity rates. − Inhibiting platelet activation and aggregation is a useful strategy for discovering new drugs to prevent or treat thrombosis diseases. , For antiplatelet drugs currently in clinical use, there are still bleeding tendency side effects . Therefore, the development of new antiplatelet/antithrombotic drugs to overcome the side effects such as bleeding has scientific and clinical significance.…”

“…4,5 For antiplatelet drugs currently in clinical use, there are still bleeding tendency side effects. 6 Therefore, the development of new antiplatelet/antithrombotic drugs to overcome the side effects such as bleeding has scientific and clinical significance.…”