The efficacy and safety of P2Y12 inhibitor monotherapy in patients after percutaneous coronary intervention

Abstract

The optimal antiplatelet therapy after percutaneous coronary intervention (PCI) remains to be elucidated. Monotherapy with a P2Y12 inhibitor may be inferior to dual antiplatelet therapy in patients after PCI. PubMed, EMBASE (by Ovidsp), Web of Science, and The Cochrane Library were searched from database inception to 2 October 2019. The composite of cardiovascular outcomes, all‐cause mortality, myocardial infarction (MI), stroke, stent thrombosis, and major bleeding were evaluated. Pooled outcomes were presented as relative risk (RR) and 95% confidence intervals (CIs). A total of four trials randomizing 29 089 participants were included. Compared with the dual antiplatelet therapy group (n = 14 559), the P2Y12 inhibitor monotherapy group (n = 14 530) significantly decreased the incidence of bleeding events (2.0% vs 3.1%; RR: 0.60; 95% CI: 0.43‐0.84; P = .005). There were no significant differences in all‐cause mortality (1.3% vs 1.5%; RR: 0.87; 95% CI, 0.71‐1.06; P = .16), myocardial infarction (2.1% vs 1.9%; RR, 1.06; 95% CI, 0.90‐1.25; P = .46), stroke (0.6% vs 0.5%; RR, 1.18; 95% CI, 0.67‐2.07; P = .57), or stent thrombosis (0.5% vs 0.4%; RR, 1.14; 95% CI, 0.81‐1.61; P = .44) between the two groups. P2Y12 inhibitor monotherapy did not show any significant difference in the adverse cardiac and cerebrovascular events, but markedly decreased the risk of bleeding among patients after PCI vs dual antiplatelet therapy. However, it still needs to be further confirmed due to limited data.

Efficacy and Safety of Ticagrelor Monotherapy in Patients Undergoing Percutaneous Coronary Intervention: A Meta‐Analysis

“…Further studies investigating the particular concept of P2Y 12 inhibitor/ticagrelor monotherapy are needed to underscore and confirm this result. Indeed, the reduction of major bleeding following PCI is an important clinical aim, due to its strong association with mortality 25 . All three trials 18–20 in this analysis compared short‐term DAPT followed by ticagrelor monotherapy to standard DAPT.…”

“…Indeed, the reduction of major bleeding following PCI is an important clinical aim, due to its strong association with mortality. 25 All three trials 18 , 19 , 20 in this analysis compared short‐term DAPT followed by ticagrelor monotherapy to standard DAPT. Conceivably, it is easier to demonstrate less bleeding with a single antiplatelet therapy regimen than with a DAPT regimen, and our meta‐analysis confirmed the significant reduction of major bleeding events with short‐term DAPT followed by ticagrelor monotherapy compared with standard DAPT.…”

Identifying the Incidence, Predictors, Outcomes, and Prevention of Stent Thrombosis (ST) in Post-percutaneous Coronary Revascularization Patients With Drug-Eluting Stents (DES): A Systematic Review

“…A pooled analysis of RCTs showed nonsignificant differences in ST between DAPT and monotherapy groups (0.5% for DAPT vs. 0.4% for monotherapy; RR, 1.14; 95% CI, 0.81-1.61; P = 0.44). However, the available data in this area is limited, and further RCTs are necessary to confirm and establish these findings [22].…”