Comparison of P2Y12 inhibitors vs. aspirin monotherapy following dual antiplatelet therapy in patients after percutaneous coronary intervention: a systematic review and meta-analysis. [Review]

Abstract

Introduction: P2Y12 inhibitor monotherapy has emerged as a potential alternative to aspirin following dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI), but the optimal choice remains uncertain.

Methods: A systematic literature search compared P2Y12 inhibitors with aspirin post PCI. A random-effects model pooled odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes.

Results: Seven studies (29,756 patients) were included. P2Y12 inhibitors significantly reduced MACE compared to aspirin [OR = 0.73; 95% CI: 0.64-0.84]. No significant difference was observed in all-cause mortality [OR = 0.90; 95% CI: 0.77-1.05], cardiac death [OR = 0.86; 95% CI: 0.68-1.09], major bleeding [OR = 1.06; 95% CI: 0.67-1.68], MI [OR = 0.78; 95% CI: 0.56-1.08], or stent thrombosis [OR = 0.71; 95% CI: 0.41-1.22]. P2Y12 inhibitors significantly reduced repeat revascularisation [OR = 0.83; 95% CI: 0.73-0.94] and stroke [OR = 0.63; 95% CI: 0.48-0.81].

Conclusions: P2Y12 inhibitors may be a safer, more effective alternative to aspirin alone after PCI.