Efficacy and safety of ticagrelor monotherapy versus dual-antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent in patients with diabetes mellitus: A systematic review and meta-analysis.
- Author:
Billy Joseph David
1
;
Althea Nicole Tanedo
1
;
John Derrik Tee
1
;
Ferdinand R. Gerodias Jr.
2
Author Information
- Publication Type:Review
- Keywords: Dual-antiplatelet Therapy
- MeSH: Bleeding; Hemorrhage; Diabetes Mellitus; Percutaneous Coronary Intervention; Thrombosis; Ticagrelor
- From: Philippine Journal of Cardiology 2023;51(2):56-62
- CountryPhilippines
- Language:English
-
Abstract:
BACKGROUND
Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the standard for the prevention of thrombotic events in patients undergoing percutaneous coronary intervention (PCI). Type 2 diabetes mellitus (DM) patients are a subgroup with a higher risk of bleeding and thrombotic events after PCI.
OBJECTIVESThis meta-analysis aimed to determine whether ticagrelor monotherapy after an initial short-course DAPT is an effective and safe option in preventing thrombotic events among DM patients undergoing PC.
METHODSA systematic review and meta-analysis was done on randomized controlled trials (RCT) comparing ticagrelor monotherapy following short-course DAPT versus conventional DAPT in T2DM patients who underwent PCI. Outcome measures for major bleeding, myocardial infarction, and all-cause mortality were extracted and analyzed using a random-effects model via RevMan version 5.3.
RESULTSA total of three RCTs, with 7482 patients, were analyzed. There were no significant differences in major bleeding (P = 0.26) and myocardial infarction (P = 0.66) events between the ticagrelor and DAPT groups. However, there was a higher rate of all-cause mortality in the DAPT group, which was statistically significant (risk ratio, 0.76; 95% confidence interval, 0.59–0.98; P = 0.03).
CONCLUSIONTicagrelor monotherapy following short course DAPT and conventional DAPT have similar rates of major bleeding and myocardial infarction among DM patients undergoing PCI with DES. However, conventional DAPT has a higher incidence of all-cause mortality, which suggests that ticagrelor monotherapy after short-course DAPT may be a preferable antiplatelet strategy in DM patients undergoing PCI.
- Full text:20241101141738159601.pdf