Potent P2Y12 Inhibitor Selection and De-escalation Strategies in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: Systematic Review and Meta-analysis

• DOI: 10.1016/j.cjco.2023.11.024
• Publication Date: 2023-12-05T23:32:25Z
• Authors: Laurie-Anne Boivi...; Kevin R. Bainey; Guillaume Marquis...; Michelle M. Graham
• Keywords: De-escalation

Balancing the effects of dual antiplatelet therapy (DAPT) in era potent purinergic receptor type Y, subtype 12 (P2Y12) inhibitors remains a challenge management acute coronary syndrome (ACS). We conducted systematic review and meta-analysis following 2-stage process consisting searching for reviews published between 2019 November 2022. included randomized controlled trials (RCTs) ACS patients treated with percutaneous intervention comparing (i) ticagrelor- vs prasugrel-based DAPT (ii) P2Y12 inhibitor de-escalation strategies. Outcomes interest were major adverse cardiovascular events (MACE), all-cause death, stent thrombosis, bleeding. estimated risk ratios (RRs) 95% confidence intervals (CIs) using random-effects model. Eight RCTs (n = 5571) compared ticagrelor to prasugrel. Ticagrelor was associated an increased MACE prasugrel (RR 1.23, CI 1.01-1.49, moderate certainty), without significant differences or In 2 3343) clopidogrel-based after 1 month inhibitor-based continuation, clopidogrel did not significantly alter incidence MACE, but reduced that bleeding 0.51, 0.28-0.92, high certainty). The effect dose inconclusive all outcomes based on one trial. increase prasugrel, low-certainty evidence, whereas decrease increasing thrombotic post-percutaneous intervention.