| Background:Percutaneous coronary intervention(PCI)is an effective means of improving blood supply and reducing clinical symptoms for patients with severe coronary heart disease such as angina pectoris and myocardial infarction.The effect of aspirin on secondary prevention of coronary atherosclerotic cardiovascular disease has been demonstrated in previous randomized controlled trials and has been recommended for long-term monotherapy maintenance in patients who have finished the planned time of Dual antiplatelet therapy(DAPT)after PCI,In patients with intolerance or allergy,P2Y12 receptor antagonist clopidogrel or ticagrelor can be replaced as alternative drugs.Clopidogrel is more widely used than ticagrelor in the clinical base of our country.Gastrointestinal bleeding is a common complication during antiplatelet therapy after PCI.Long-term follow-up results show that there is no significant difference in the long-term prognosis of patients treated with clopidogrel and those treated with aspirin,and the risk of bleeding is lower.How to optimize antiplatelet therapy after PCI and reduce the risk of bleeding while reducing the occurrence of thrombotic events has been the focus of clinical attention in recent years.This paper conducted a meta-analysis on the effectiveness and safety of follow-up aspirin or clopidogrel in patients who completed the scheduled time dual antiplatelet therapy.The aim is to provide more basis for individualized antiplatelet therapy.Methods:Randomized controlled trials or observational studies were searched in six databases,including Pub Med,Web of science,CNKI,VIP,and China Biomedical Literature Database(CBM).The search will be available until December 2022.Retrieval and screening,data extraction and quality evaluation were all completed by two researchers alone.In terms of quality evaluation,randomized trials were evaluated by the modified Jadad scale,and observational studies were evaluated by the Newcastle Ottawa Scale(NOS).After data extraction,statistical analysis was conducted by Revman5.3 software.Results:After the completion of DAPT,clopidogrel monotherapy was superior to aspirin associated with MACE(RR=0.78,95%CI(0.67,0.91),P=0.002<0.05).Any stroke(RR=0.51,95%CI(0.35,0.76),P=0.0008<0.05);Hemorrhagic stroke(RR=0.24,95%CI(0.09,0.68),P=0.007<0.05);Ischemic stroke(RR=0.55,95%CI(0.32,0.94),P=0.03<0.05);Gastrointestinal events(RR=0.82,95%CI(0.72,0.94),P=0.005<0.05);Major bleeding(RR=0.63,95%CI(0.46,0.87),P=0.006<0.05).Compared with all-cause death(RR=1.06,95%CI(0.81,1.39),P=0.66 > 0.05);Cardiogenic death(RR=0.87,95%CI(0.60,1.25),P=0.45>0.05);Myocardial infarction(RR=0.96,95%CI(0.71,1.29),P=0.79>0.05);In-stent restenosis(RR=0.86,95%CI(0.55,1.35),P=0.52>0.05);Vessel revascularization(RR=0.88,95%CI(0.71,1.08),P=0.22>0.05);Composite thrombotic endpoint(RR=0.86,95%CI(0.72,1.04),P=0.12> 0.05),there was no significant difference in long-term prognosis between clopidogrel and aspirin.Conclusion:1.After the completion of designated DAPT,long-term clopidogrel monotherapy is safer than aspirin in MACE,major bleeding,stroke,and gastrointestinal events.2.There was no significant difference in safety between clopidogrel and aspirin in all-cause death,cardiogenic death,myocardial infarction,in-stent restenosis,vessel revascularization and composite thrombotic endpoint. |
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