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Original Article   

Minerva Cardiology and Angiology 2022 Mar 25

DOI: 10.23736/S2724-5683.22.06038-0

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Duration and kind of dual antiplatelet therapy for acute coronary syndrome patients: a network meta-analysis

Fabrizio D'ASCENZO 1, Ovidio DE FILIPPO 1, Filippo ANGELINI 1 , Francesco PIROLI 1, Giulia DE LIO 1, Pier Paolo BOCCHINO 1, Luca BALDETTI 2, Francesco MELILLO 2, Alaide CHIEFFO 3, Andrea SAGLIETTO 1, Pierluigi OMEDÈ 1, Antonio MONTEFUSCO 1, Federico CONROTTO 1, Gaetano M. DE FERRARI

1 Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Turin, Italy; 2 Cardiac Intensive Care Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy; 3 Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele Scientific Institute, Milan, Italy


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BACKGROUND: For acute coronary syndrome (ACS) patients treated with percutaneous coronary intervention (PCI), the choice of the duration and kind of dual antiplatelet therapy (DAPT) offering the most accurate balance between ischemic and bleeding risk remains unknown.
METHODS: A network meta-analysis was performed including all Randomized Controlled Trials (RCTs) comparing different DAPT regimens and duration in ACS patients undergoing PCI. Trial-defined MACE and major bleedings were the primary endpoints. Stroke, stent thrombosis (ST), all-cause and cardiovascular death, myocardial infarction (MI) represented secondary endpoints.
RESULTS: 13 RCTs encompassing 46145 patients were included. Mean age was 62 (61-64) years old, 42% being admitted with STEMI, 33% with NSTEMI and 25% with UA. The competitive arms were: clopidogrel and aspirin for 12 months (6 arms/18183 patients), clopidogrel and aspirin for 6 months (4/3329), clopidogrel and aspirin > 12 months (3/2238), ticagrelor and aspirin for 12 months (6/12942) and prasugrel and aspirin for 12 months (3/9453). Trial-defined MACE and major bleedings, stroke and death were similar among the different arms. DAPT with prasugrel and aspirin for 12 months reduced MI compared to aspirin and clopidogrel for 12 months (OR 0.71, 95%CI 0.54.0.94), and reduced the risk of ST compared to ticagrelor (OR 0.66, 95%CI 0.49-0.90). Both prasugrel and ticagrelor reduced ST as compared to clopidogrel and aspirin for 12 months.
CONCLUSIONS: Different DAPT strategies yield similar risk of MACE, major bleeding, death and stroke in ACS patients. Prasugrel and aspirin for 12 months proved to be the most effective strategy regarding ST and MI.


KEY WORDS: Acute coronary syndromes; Dual antiplatelet therapy; Meta-analysis

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