AIMS: Patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) are recommended to be placed on potent P2Y12 blockade. However, the long-term bleeding risk is high. Therefore, despite no definitive evidence, switching to clopidogrel beyond the acute phase is common. We aimed to evaluate the clinical outcomes of antiplatelet de-escalation compared with continuation in patients treated with PCI. METHODS: We searched databases for randomized clinical trials (RCTs) that evaluated the safety and efficacy of antiplatelet de-escalation compared with continuation in patients treated with PCI. Pooled summary estimates were calculated. RESULTS: We included 3 RCTs with 3391 patients (median follow-up: 12 months). Compared with the continued group, the net clinical outcome (composite of bleeding or thrombotic events) was significantly reduced in the group switched to clopidogrel (8.7% vs 12.1%; risk ratio [RR]: 0.64; 95% confidence interval [CI]: 0.43-0.97; P = .03). However, there were similar clinical outcomes between groups for major adverse cardiovascular events (MACE; RR: 0.78; 95% CI: 0.55-1.11; P = .17), all Bleeding Academic Research Consortium (BARC) types bleeding (RR: 0.61; 95% CI: 0.33-1.11; P = .10), or BARC types ≥2 bleeding (RR: 0.49; 95% CI: 0.19-1.26; P = .14). CONCLUSIONS: Our results suggest a net clinical benefit of de-escalation therapy shortly after PCI, without increased risk of MACE. Larger randomized trials will be necessary to confirm these findings.
AIMS: Patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) are recommended to be placed on potent P2Y12 blockade. However, the long-term bleeding risk is high. Therefore, despite no definitive evidence, switching to clopidogrel beyond the acute phase is common. We aimed to evaluate the clinical outcomes of antiplatelet de-escalation compared with continuation in patients treated with PCI. METHODS: We searched databases for randomized clinical trials (RCTs) that evaluated the safety and efficacy of antiplatelet de-escalation compared with continuation in patients treated with PCI. Pooled summary estimates were calculated. RESULTS: We included 3 RCTs with 3391 patients (median follow-up: 12 months). Compared with the continued group, the net clinical outcome (composite of bleeding or thrombotic events) was significantly reduced in the group switched to clopidogrel (8.7% vs 12.1%; risk ratio [RR]: 0.64; 95% confidence interval [CI]: 0.43-0.97; P = .03). However, there were similar clinical outcomes between groups for major adverse cardiovascular events (MACE; RR: 0.78; 95% CI: 0.55-1.11; P = .17), all Bleeding Academic Research Consortium (BARC) types bleeding (RR: 0.61; 95% CI: 0.33-1.11; P = .10), or BARC types ≥2 bleeding (RR: 0.49; 95% CI: 0.19-1.26; P = .14). CONCLUSIONS: Our results suggest a net clinical benefit of de-escalation therapy shortly after PCI, without increased risk of MACE. Larger randomized trials will be necessary to confirm these findings.
Authors: Jacek Kubica; Piotr Adamski; Piotr Niezgoda; Aldona Kubica; Przemysław Podhajski; Malwina Barańska; Julia M Umińska; Łukasz Pietrzykowski; Małgorzata Ostrowska; Jolanta M Siller-Matula; Jolita Badarienė; Stanisław Bartuś; Andrzej Budaj; Sławomir Dobrzycki; Łukasz Fidor; Mariusz Gąsior; Jacek Gessek; Marek Gierlotka; Robert Gil; Jarosław Gorący; Paweł Grzelakowski; Tomasz Hajdukiewicz; Miłosz Jaguszewski; Marianna Janion; Jarosław Kasprzak; Adam Kern; Artur Klecha; Andrzej Kleinrok; Wacław Kochman; Bartosz Krakowiak; Jacek Legutko; Maciej Lesiak; Marcin Nosal; Grzegorz Piotrowski; Andrzej Przybylski; Tomasz Roleder; Grzegorz Skonieczny; Grzegorz Sobieszek; Agnieszka Tycińska; Dariusz Wojciechowski; Wojciech Wojakowski; Jarosław Wójcik; Marzenna Zielińska; Aleksander Żurakowski; Giuseppe Specchia; Diana A Gorog; Eliano P Navarese Journal: Cardiol J Date: 2021-06-07 Impact factor: 2.737