Efficacy And Safety Of Dual Antiplatelet Therapy After Percutaneous Coronary Drug-eluting Stenting:A Network Meta-analysis

Objective:To evaluate the efficacy and safety of dual antiplatelet antiplatelet regimens after coronary drug-eluting stents by network meta-analysis.Methods:PubMed,The Cochrane Library,EMbase and Web of Science databases were electronically searched to collect randomized controlled trials(RCTs)of the comparison of different dual antiplatelet regimens after coronary drug-eluting stenting from inception to December 31st,2020.Two reviewers independently screened literature,extracted data and assessed the risk bias of included studies.Network meta-analysis was then performed by using ADDIS 1.16.7,RevMan 5.3 and STATA 16.0 software.Results:A total of 27 RCTs involving 79,880 patients were included.The results of network meta-analysis showed that:in terms of prevention of myocardial infarction(MI)recurrence,the long-term dual antiplatelet therapy was superior to the aspirin monotherapy after short-term dual antiplatelet therapy(OR=0.50,95%CI 0.37 to 0.70),the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy(OR=0.63,95%CI 0.44 to 0.96)and the standard dual antiplatelet therapy(OR=0.58,95%CI 0.45 to 0.77).In terms of prevention of stent thrombosis(ST),the long-term dual antiplatelet therapy was also superior to the aspirin monotherapy after short-term dual antiplatelet therapy(OR=0.43,95%CI 0.26 to 0.69),the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy(OR=0.42,95%CI 0.21 to 0.89)and the standard dual antiplatelet therapy(OR=0.48,95%CI 0.31 to 0.78).There was no statistically significant difference among the four interventions in prevention of stroke and in reducing of all-cause mortality(P>0.05).In terms of prevention of cardiovascular and cerebrovascular adverse compound events,the long-term dual antiplatelet therapy was also superior to the aspirin monotherapy after short-term dual antiplatelet therapy(OR=0.79,95%CI 0.67 to 0.94)and the standard dual antiplatelet therapy(OR=0.79,95%CI 0.69 to 0.91).In terms of safety,bleeding rate of the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy was lower than that of the aspirin monotherapy after short-term dual antiplatelet therapy(OR=0.70,95%CI 0.53 to 0.93),the standard dual antiplatelet therapy(OR=0.54,95%CI 0.42 to 0.66)and the long-term dual antiplatelet therapy(OR=0.35,95%CI 0.26 to 0.50).Bleeding rate of the aspirin monotherapy after short-term dual antiplatelet therapy was lower than that of the standard dual antiplatelet therapy(OR=0.76,95%CI 0.64 to 0.90)and the long-term dual antiplatelet therapy(OR=0.50,95%CI 0.39 to 0.67).Bleeding rate of the standard dual antiplatelet therapy was lower than that of the long-term dual antiplatelet therapy(OR=0.66,95%CI 0.53 to 0.87).The probability ranking diagram showed that:in terms of MI,ST and cardiovascular and cerebrovascular adverse compound events,the recurrence rate of the long-term dual antiplatelet therapy all was the lowest.However,MI and cardiovascular and cerebrovascular adverse compound events recurrence rate of the aspirin monotherapy after short-term dual antiplatelet therapy all was the highest.ST recurrence rate of the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy was the highest.In terms of stroke,Bleeding and all-cause mortality,the incidence rate of the long-term dual antiplatelet therapy all was the highest.However,all-cause mortality and bleeding incidence rate of the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy all was the lowest.Stroke incidence rate of the aspirin monotherapy after short-term dual antiplatelet therapy was the lowest.Conclusion:The available evidence suggests that when the risk of ischemia is low and bleeding is high,the aspirin or P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy should be recommended,and P2Y12 inhibitor monotherapy have a lower risk of bleeding and may be more effective than aspirin monotherapy.When the risk of ischemia is high and bleeding is low,the standard or long-term dual antiplatelet therapy should be recommended,and the long-term dual antiplatelet therapy have lower safety and may have a higher risk of all-cause mortality.However,the long-term dual antiplatelet therapy have more effective.Therefore,we should carefully weigh treatment options.