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.

• Authors: Liman Luo, Menglu Fu, Yuanyuan Li, Zhihui Chen, Jing Yu, Jinlan Luo, Shuiqing Hu, Ling Tu, Xizhen Xu
• Journal: Clinical cardiology (Clin Cardiol) Vol. 43 Issue 3 Pg. 235-241 (Mar 2020) ISSN: 1932-8737 [Electronic] United States
• PMID: 31777973 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

Chemical References

• P2RY12 protein, human
• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists
• Receptors, Purinergic P2Y12

Topics

• Aged
• Blood Platelets (drug effects, metabolism)
• Coronary Artery Disease (diagnosis, mortality, therapy)
• Coronary Thrombosis (mortality, prevention & control)
• Female
• Hemorrhage (chemically induced)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (mortality, prevention & control)
• Percutaneous Coronary Intervention (adverse effects, instrumentation, mortality)
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Purinergic P2Y Receptor Antagonists (adverse effects, therapeutic use)
• Randomized Controlled Trials as Topic
• Receptors, Purinergic P2Y12 (blood, drug effects)
• Risk Assessment
• Risk Factors
• Stents
• Stroke (mortality, prevention & control)
• Time Factors
• Treatment Outcome