Clopidogrel Versus Aspirin as Monotherapy Following Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome Receiving a Drug-Eluting Stent: A Systematic Literature Review and Meta-Analysis

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS

ACS Applied Bio Materials Pub Date : 2024-08-29 DOI:10.1002/clc.24326

Dirk Sibbing, Johny Nicolas, Alessandro Spirito, Birgit Vogel, Davide Cao, Wanda Stipek, Ellen Kasireddy, Andi Qian, Irfan Khan, Roxana Mehran

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引用次数: 0

Abstract

Objective

This study aimed to evaluate the comparative effectiveness and safety of clopidogrel versus aspirin as monotherapy following adequate dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS).

Methods

MEDLINE, Embase, and CENTRAL were searched from database inception to September 1, 2023. Randomized controlled trials (RCTs) and observational studies evaluating the effectiveness or safety of clopidogrel versus aspirin as monotherapy following DAPT in patients with ACS who received a drug-eluting stent were included. Random-effects meta-analyses were conducted to compare risks of major adverse cardiovascular events (MACE) and clinically relevant bleeding.

Results

Of 6242 abstracts identified, three unique studies were included: one RCT and two retrospective cohort studies. Studies included a total of 7081 post-percutaneous coronary intervention ACS patients, 4260 of whom received aspirin monotherapy and 2821 received clopidogrel monotherapy. Studies included variable proportions of patients with ST-elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. From the meta-analysis, clopidogrel was associated with a 28% reduction in the risk of MACE compared with aspirin (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.54, 0.98), with no significant difference in clinically relevant bleeding (HR: 0.92; 95% CI: 0.68, 1.24).

Conclusion

Despite the paucity of published evidence on the effectiveness and safety of clopidogrel versus aspirin in patients with ACS post-drug-eluting stent implantation, this meta-analysis suggests that clopidogrel versus aspirin may result in a lower risk of MACE, with a similar risk of major bleeding. The present results are hypothesis-generating and further large RCTs comparing antiplatelet monotherapy options in ACS patients are warranted.

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查看原文本刊更多论文

接受药物洗脱支架治疗的急性冠状动脉综合征患者在接受双联抗血小板疗法后单用氯吡格雷与阿司匹林：系统性文献综述和元分析

目的本研究旨在评估在急性冠状动脉综合征（ACS）患者接受充分的双联抗血小板疗法（DAPT）后，氯吡格雷单药治疗与阿司匹林单药治疗的有效性和安全性比较。方法检索从数据库开始到 2023 年 9 月 1 日的 MEDLINE、Embase 和 CENTRAL。纳入了对接受药物洗脱支架治疗的 ACS 患者在 DAPT 后单药治疗氯吡格雷与阿司匹林的有效性或安全性进行评估的随机对照试验 (RCT) 和观察性研究。进行了随机效应荟萃分析，以比较主要不良心血管事件（MACE）和临床相关出血的风险。结果在确定的 6242 篇摘要中，纳入了三项独特的研究：一项 RCT 和两项回顾性队列研究。研究共纳入 7081 例经皮冠状动脉介入治疗后 ACS 患者，其中 4260 例接受阿司匹林单药治疗，2821 例接受氯吡格雷单药治疗。研究纳入了不同比例的ST段抬高型心肌梗死（STEMI）、非STEMI和不稳定型心绞痛患者。荟萃分析结果表明，与阿司匹林相比，氯吡格雷可将MACE风险降低28%（危险比[HR]：0.72；95%置信区间[CI]：0.54, 0.98），而临床相关出血方面无显著差异（HR：0.92；95% CI：0.68, 1.24）。结论尽管有关药物洗脱支架植入术后 ACS 患者使用氯吡格雷与阿司匹林的有效性和安全性的已发表证据很少，但这项荟萃分析表明，氯吡格雷与阿司匹林相比，MACE 风险较低，大出血风险相似。本研究结果具有假设性，有必要进一步开展大型 RCT 研究，比较 ACS 患者的抗血小板单药治疗方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Bio Materials Chemistry-Chemistry (all)

CiteScore

9.40

自引率

2.10%

发文量

464