Prognostic impact of antiplatelet therapy in Takotsubo syndrome: a systematic review and meta-analysis of the literature

Abstract

While the most recent evidence suggests a lack of benefit, antithrombotic therapy is still extensively prescribed in patients with Takotsubo syndrome (TTS). The objective of this study was to determine whether patients with TTS benefit from anti-aggregation, in terms of either short-term or long-term outcomes. A systematic review and meta-analysis was conducted. A comprehensive search of the literature included MEDLINE, Cochrane Library, Clinicaltrials.gov, EU Clinical Trial Register, References, and contact with the authors. Methodological quality assessment and data extraction were systematically performed. The review adhered to the PRISMA framework guidelines. A total of 86 citations were identified, six being eligible for inclusion, for a total of 1997 patients. One of them considered both short-term and long-term outcomes. One reported outcomes during the index event, while the remaining four focused on potential long-term benefits. They were all retrospective cohort studies.Based on our data, the long-term use of antiplatelet therapy (AT) led to a significantly higher incidence of the composite outcome (OR: 1.54; 95% CI 1.09–2.17; p = 0.014) and overall mortality (OR 1.72; 95% CI 1.07–2.77; p = 0.027). The analysis did not show a statistically significant difference in TTS recurrences, stroke/TIA, and MI or CAD worsening with AT compared with no anti-aggregation. The AT in this settings did not show any clear benefit in improving the long-term outcomes, and it may be even detrimental and it may be detrimental. These results warrant further future research and the design of adequately powered randomized controlled trials focusing on the impact of aspirin on the outcomes in patients presenting with TTS.

Association of Aspirin Therapy with Prognosis in Patients with Nonobstructive Coronary Artery Disease: A Systematic Review and Meta-Analysis

“…Previous studies have shown that routine aspirin use does not reduce the risk of cardiovascular events in non-ischemia settings [55,56]. In addition, a metaanalysis reported that aspirin therapy might worsen the long-term prognosis of patients with Takotsubo syndrome without any bene t [57].…”

Stress-Induced Cardiomyopathy—Considerations for Diagnosis and Management during the COVID-19 Pandemic

“…Caution is needed when there is left ventricular outflow tract obstruction since inotropic agents are contraindicated in these cases while beta-blockers are beneficial in reducing the obstruction [17]. Antiplatelet therapy is not routinely recommended and may be associated with increased mortality [82]. Despite the role of catecholamine in the pathogenesis of TTS, there is no consensus that beta-blockers use is associated with decrease in TTS recurrence [22].…”

The Role of Antiplatelet Therapy in Patients With MINOCA

“…On the other hand, in a systematic review and meta-analysis including almost two thousand patients, DAPT was associated with an increase in cardiovascular events and mortality ( 50 ). Bleeding rates were not reported.…”