Efficacy and safety of ticagrelor monotherapy in patients following percutaneous coronary intervention: A systematic review and meta-analysis.

Abstract

BACKGROUND:

We aimed to systematically evaluate the efficacy and safety ticagrelor monotherapy following percutaneous coronary intervention.

METHODS:

Online databases were searched for relevant studies (published between the years 2015 and 2020) comparing 1-month Dual antiplatelet therapy (DAPT) followed by 23-month ticagrelor monotherapy with 12-month DAPT followed by 12-month aspirin monotherapy following percutaneous coronary intervention. Primary outcomes assessed efficacy whereas secondary outcomes assessed safety. Odds ratios (OR) with 95% confidence intervals (CIs) based on a random effect model were calculated and the analysis was carried out by the RevMan 5.3 software.

RESULTS:

Only 6 studies were selected for this meta-analytical research. The meta-analysis results: MI(OR:0.96, 95% CI:0.86-1.06, P = .40), stroke (OR:1.04, 95% CI: 0.87-1.25, P = .68), stent thrombosis (OR: 0.91,95% CI:0.76-1.10,P = .32),New-Q Wave (OR:0.85,95% CI: 0.72-1.00, P = .05), all cause death (OR:0.91, 95% CI: 0.87-0.96, P < .0001), death from cardiovascular (OR: 0.76, 95% CI: 0.58-0.99, P = .04), revascularization (OR: 0.93, 95% CI: 0.87-0.99, P = .03). Ticagrelor monotherapy was associated with a significantly lower rate of myocardial Infarction (MI), stroke, stent thrombosis, all cause death, death from cardiovascular and revascularization (OR:0.91,95% CI:0.87-0.96, P < .0001) when compared to DAPT. Besides, DAPT was associated with a significantly higher rate of BARC3 or 5 bleeding (OR:0.85, 95% CI: 0.68-1.06; P = .16) when compared to ticagrelor. When bleeding was further subdivided, minor or major bleeding was also significantly higher with DAPT (OR: 0.72, 95% CI: 0.41-1.27; P = .26). GUSTO moderate or severe bleeding was also significantly higher with DAPT (OR: 0.77, 95% CI: 0.39-1.52; P = .45).

CONCLUSION:

Ticagrelor monotherapy after short-term dual-antiplatelet therapy (DAPT) can optimize ischemic and bleeding risks. And, it can reduce the occurrence of events outcome (MI, revascularization, stroke, stent thrombosis).

• Authors: Wen-Bin Zhang, Li-Nan Liu, Yang Liu, Zhen Wang
• Journal: Medicine (Medicine (Baltimore)) Vol. 100 Issue 20 Pg. e26070 (May 21 2021) ISSN: 1536-5964 [Electronic] United States
• PMID: 34011127 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Platelet Aggregation Inhibitors
• Ticagrelor

Topics

• Drug Administration Schedule
• Dual Anti-Platelet Therapy
• Humans
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (administration & dosage)
• Ticagrelor (administration & dosage)