Clopidogrel Monotherapy After 1-Month Dual Antiplatelet Therapy in Patients With Diabetes Undergoing Percutaneous Coronary Intervention

Yamamoto, Ko; Watanabe, Hirotoshi; Morimoto, Takeshi; Obayashi, Yuki; Natsuaki, Masahiro; Yamaji, Kyohei; Domei, Takenori; Ogita, Manabu; Ohya, Masanobu; Tatsushima, Shojiro; Suzuki, Hitoshi; Tada, Takeshi; Ishii, Mitsuru; Nikaido, Akira; Watanabe, Naoki; Fujii, Shinya; Mori, Hiromu; Nishikura, Tenjin; Suematsu, Nobuhiro; Hayashi, Fujio; Komiyama, Kanki; Shigematsu, Tatsuya; Isawa, Tsuyoshi; Suwa, Satoru; Ando, Kenji; Kimura, Takeshi

doi:10.1016/j.jcin.2022.09.053

Cited by 5 publications

(4 citation statements)

References 38 publications

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“…In addition to the hypoglycemic treatment, DAPT and statin therapy were also associated with improved prognosis in diabetic patients [ 33 , 34 ]. These therapies exert their effects through mechanisms such as anti-thrombotic effects and reduced inflammation in atherosclerotic plaques, leading to plaque stabilization characterized by thickened fibrous caps and macrocalcification [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Association Between MIND Diet Adherence and Mortality: Insights from Diabetic and Non-Diabetic Cohorts

Song,

Chang,

Song

et al. 2023

Nutr. Diabetes

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Background/Objectives To date, evidence regarding the protective roles of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet in patients with type 2 diabetes mellitus (T2DM) is scarce. This study aims to estimate the impact of adhering to the MIND diet on the mortality in patients with and without T2DM. Subjects/Methods In this cohort study, 6887 participants (1021 patients with T2DM) from the NHANES dataset were analyzed. The exposure is the MIND diet adherence. The primary outcomes are all-cause and cardiovascular (CV) deaths. Results We documented 1087 all-cause deaths consisting of 377 CV deaths during the follow-up (median time of 10 years). Among participants with T2DM, those with a high MIND score (> 8.0, range of MIND score: 4.5–13) had a significantly lower risk of all-cause death (hazard ratio [HR] 0.75, 95% confidence interval [CI]: 0.59, 0.96, P = 0.021) and CV death (HR 0.50, 95% CI: 0.29, 0.87, P = 0.014) compared to those with a low MIND score (≤ 8.0). In participants without T2DM, a high MIND score was associated with a significant decrease in the risk of all-cause death (HR = 0.83, 95% CI: 0.70, 0.99, P < 0.001), but the association with CV death risk was not statistically significant. Conclusion This study uncovered significant associations between the MIND diet and decreased risk of all-cause and CV death in patients with T2DM. The findings highlight the potential benefits of following the MIND diet in managing and enhancing the outcomes of individuals with T2DM.

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Section: Discussionmentioning

confidence: 99%

Association Between MIND Diet Adherence and Mortality: Insights from Diabetic and Non-Diabetic Cohorts

Song,

Chang,

Song

et al. 2023

Nutr. Diabetes

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“…38 For patients after PCI operation, there is also evidence that better long-term clinical outcomes could be achieved if patients were reversed to clopidogrel monotherapy after 1-month dual therapy. 39 However, in our sensitivity analysis of patients on clopidogrel monotherapy in the primary care setting, we observed an increased risk of stroke events in LoF variant carriers. This result provided supporting evidence against giving clopidogrel monotherapy if the patient is an IM or PM.…”

Section: Articlementioning

confidence: 69%

“…After a short period of dual antiplatelet therapy, transitioning to clopidogrel monotherapy is a recommended long‐term treatment strategy for patients with ischemic stroke 38 . For patients after PCI operation, there is also evidence that better long‐term clinical outcomes could be achieved if patients were reversed to clopidogrel monotherapy after 1‐month dual therapy 39 . However, in our sensitivity analysis of patients on clopidogrel monotherapy in the primary care setting, we observed an increased risk of stroke events in LoF variant carriers.…”

Section: Discussionmentioning

confidence: 99%

CYP2C19 Loss‐of‐Function Variants Associated With Long‐Term Ischemic Stroke Events During Clopidogrel Treatment in the Chinese Population

Wu,

Liu,

Tian

et al. 2023

Clin Pharma and Therapeutics

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This study aims to determine whether CYP2C19 loss‐of‐function (LoF) variants were associated with long‐term ischemic stroke risk in Chinese primary care patients treated with clopidogrel. Patients treated with clopidogrel were ascertained from Chinese electronic medical records linked with a biobank for a retrospective cohort study. Their medical information was examined for the period from January 2018 to December 2021. Two CYP2C19 major loss of function variants (*2:rs4244285 and *3: rs4986893) were genotyped. The clinical outcome was ischemic stroke event. Cox regression analysis was used to evaluate the association between the occurrence of ischemic stroke events and CYP2C19 LoF variants. Covariates included age, gender, body mass index, prior ischemic stroke, transient ischemic attack, hypertension, diabetes mellitus, hyperlipoidemia, smoke status, aspirin use, proton‐pump inhibitor use, and statin use. Of the 1,141 patients included in the clopidogrel therapy cohort, 61.9% carried at least one CYP2C19 LoF variant. During a median follow‐up period of 12 months, 103 patients (9.0%) had an ischemic stroke. After adjusting for other risk factors, carriers of CYP2C19 LoF variants had significantly higher risk of ischemic stroke compared with non‐carriers (hazard ratio: 1.64, 95% confidence interval: 1.06–2.53, P = 0.025). This pharmacogenetic study of clopidogrel provides novel insights into the association between the CYP2C19 LoF variant and long‐term stroke risk. We established that there is still a need for CYP2C19 genotype‐guided personalized antiplatelet therapy in those who have returned to the primary care setting for clopidogrel prescription.

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“…Through consideration of the reference lists of these studies, a total of 9 reports for 8 trials were ultimately deemed eligible for inclusion in our systematic review and meta-analysis. [11][12][13][14][15][16][17][18][19] Our systematic search of literature is depicted in Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart (see Figure, Supplemental Digital Content 1, http://links.lww.com/JCVP/B8).…”

Section: Search Resultsmentioning

confidence: 99%

Duration Of Dual Antiplatelet Treatment After Percutaneous Coronary Intervention In Patients With Diabetes: A Systematic Review And Meta-Analysis

Apostolos,

Travlos,

Tsioulos

et al. 2023

Journal of Cardiovascular Pharmacology

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Aim of our systematic review and meta-analysis is to compare shortened (≤3 months) dual antiplatelet therapy (DAPT) with longer DAPT in diabetic patients undergoing percutaneous coronary interventions (PCI). We systematically screened three major databases (Medline, Cochrane Central Register of Controlled Trials and Scopus) searching for randomized-controlled trials or sub-analyses of them, which compared shortened (S-DAPT) to longer (L-DAPT) regimens of DAPT. Primary endpoint of systematic review and meta-analysis is the NACE (Net Adverse Cardiac Events) and secondary are MACE (Major Adverse Cardiac Events), mortality, bleedings, myocardial infarction and stent thrombosis. Subgroup analyses included studies using only ticagrelor-based regimens and three-months duration of DAPT. A total of eight studies and 12,665 patients were included in our analysis. Our meta-analysis met its primary endpoint, as S-DAPT was associated significantly with a reduced risk ratio (RR) by 17% [RR: 0.83, 95% Confidence Intervals (CI): 0.72-0.96]. Non-significant difference among the rest endpoints was detected between the two groups. Subgroup analyses showed that ticagrelor-based regimens were associated with a significant reduction of mortality (RR: 0.67, 95% CI: 0.48-0.93) and three-months DAPT reduced furtherly NACE by 27% (RR:0.73, 95% CI: 0.60-0.89). In conclusion, our systematic review and meta-analysis showed that (i) S-DAPT was significantly associated with a lower incidence of NACE, (ii) ticagrelor-based S-DAPT was associated with decreased mortality rates, and (iii) the benefit of three-months duration of DAPT achieved an even greater NACE reduction. Thus, S-DAPT could be considered as a safe and feasible option in diabetic patients.

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Clopidogrel Monotherapy After 1-Month Dual Antiplatelet Therapy in Patients With Diabetes Undergoing Percutaneous Coronary Intervention

Cited by 5 publications

References 38 publications

Association Between MIND Diet Adherence and Mortality: Insights from Diabetic and Non-Diabetic Cohorts

Association Between MIND Diet Adherence and Mortality: Insights from Diabetic and Non-Diabetic Cohorts

CYP2C19 Loss‐of‐Function Variants Associated With Long‐Term Ischemic Stroke Events During Clopidogrel Treatment in the Chinese Population

Duration Of Dual Antiplatelet Treatment After Percutaneous Coronary Intervention In Patients With Diabetes: A Systematic Review And Meta-Analysis

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