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Apostolos A, Chlorogiannis DD, Chrysostomidis G, Bozika M, Timpilis F, Kramvis A, Karamasis GV, Leventopoulos G, Davlouros P, Tsigkas G. Efficacy and Safety of Thirty-Day Dual-Antiplatelet Therapy Following Complex Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2024; 11:43. [PMID: 38392257 PMCID: PMC10889500 DOI: 10.3390/jcdd11020043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
The optimal duration of DAPT after complex PCI remains under investigation. The purpose of this systematic review and meta-analysis was to explore the safety and efficacy of a one-month therapy period versus a longer duration of DAPT after complex PCI. We systematically screened three major databases, searching for randomized controlled trials or sub-analyses of them, which compared shortened DAPT (S-DAPT), namely, one month, and longer DAPT (L-DAPT), namely, more than three months. The primary endpoint was any Net Adverse Clinical Event (NACE), and the secondary was any MACE (Major Adverse Cardiac Event), its components (mortality, myocardial infarction, stroke, and stent thrombosis), and major bleeding events. Three studies were included in the analysis, with a total of 6275 patients. Shortening DAPT to 30 days after complex PCI did not increase the risk of NACEs (OR: 0.77, 95% CI: 0.52-1.14), MACEs, mortality, myocardial infractions, stroke, or stent thrombosis. Pooled major bleeding incidence was reduced, but this finding was not statistically significant. This systematic review and meta-analysis showed that one-month DAPT did not differ compared to a longer duration of DAPT after complex PCI in terms of safety and efficacy endpoints. Further studies are still required to confirm these findings.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece;
| | | | | | - Maria Bozika
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (M.B.); (F.T.); (A.K.); (G.L.); (P.D.)
| | - Filippos Timpilis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (M.B.); (F.T.); (A.K.); (G.L.); (P.D.)
| | - Angelos Kramvis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (M.B.); (F.T.); (A.K.); (G.L.); (P.D.)
| | - Grigoris V. Karamasis
- Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Rimini 1, Chaidari, 124 62 Athens, Greece;
| | - Georgios Leventopoulos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (M.B.); (F.T.); (A.K.); (G.L.); (P.D.)
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (M.B.); (F.T.); (A.K.); (G.L.); (P.D.)
| | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (M.B.); (F.T.); (A.K.); (G.L.); (P.D.)
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Apostolos A, Travlos C, Tsioulos G, Chlorogiannis DD, Karanasos A, Papafaklis M, Alexopoulos D, Toutouzas K, Davlouros P, Tsigkas G. Duration of Dual Antiplatelet Treatment After Percutaneous Coronary Intervention in Patients With Diabetes: A Systematic Review and Meta-analysis. J Cardiovasc Pharmacol 2024; 83:64-72. [PMID: 37944149 DOI: 10.1097/fjc.0000000000001503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/02/2023] [Indexed: 11/12/2023]
Abstract
Aim of our systematic review and meta-analysis is to compare shortened (≤3 months) dual antiplatelet therapy (DAPT) with longer DAPT in diabetic patients undergoing percutaneous coronary interventions.We systematically screened 3 major databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus) searching for randomized-controlled trials or subanalyses of them, which compared shortened DAPT (S-DAPT) with longer DAPT regimens of DAPT. Primary end point of systematic review and meta-analysis is the net adverse clinical events (NACE), and secondary are major adverse cardiac events (MACE), mortality, bleedings, myocardial infarction, and stent thrombosis. Subgroup analyses included studies using only ticagrelor-based regimens and 3-month duration of DAPT.A total of 8 studies and 12,665 patients were included in our analysis. Our meta-analysis met its primary end point because S-DAPT was associated significantly with a reduced risk ratio (RR) by 17% [RR: 0.83, 95% confidence intervals (CI), 0.72-0.96]. Nonsignificant difference among the rest end points was detected between the 2 groups. Subgroup analyses showed that ticagrelor-based regimens were associated with a significant reduction of mortality (RR: 0.67, 95% CI, 0.48-0.93) and 3-month DAPT reduced furtherly NACE by 27% (RR: 0.73, 95% CI, 0.60-0.89).In conclusion, our systematic review and meta-analysis showed that (i) S-DAPT was significantly associated with a lower incidence of NACE, (ii) ticagrelor-based S-DAPT was associated with decreased mortality rates, and (iii) the benefit of 3-month duration of DAPT achieved an even greater NACE reduction. Thus, S-DAPT could be considered as a safe and feasible option in diabetic patients.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, "Hippokration" General Hospital of Athens, Athens, Greece
- Department of Cardiology, Faculty of Medicine, University of Patras, University Hospital of Patras, Patras, Greece
| | - Christofer Travlos
- Department of Cardiology, Faculty of Medicine, University of Patras, University Hospital of Patras, Patras, Greece
| | - Georgios Tsioulos
- Department of Cardiology, Faculty of Medicine, University of Patras, University Hospital of Patras, Patras, Greece
| | | | - Antonios Karanasos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, "Hippokration" General Hospital of Athens, Athens, Greece
- Department of Cardiology, Faculty of Medicine, University of Patras, University Hospital of Patras, Patras, Greece
| | - Michail Papafaklis
- Department of Cardiology, Faculty of Medicine, University of Patras, University Hospital of Patras, Patras, Greece
| | - Dimitrios Alexopoulos
- Second Department of Cardiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University Hospital of Patras, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Periklis Davlouros
- Department of Cardiology, Faculty of Medicine, University of Patras, University Hospital of Patras, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, Faculty of Medicine, University of Patras, University Hospital of Patras, Patras, Greece
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Tsigkas G, Vakka A, Apostolos A, Bousoula E, Vythoulkas-Biotis N, Koufou EE, Vasilagkos G, Tsiafoutis I, Hamilos M, Aminian A, Davlouros P. Dual Antiplatelet Therapy and Cancer; Balancing between Ischemic and Bleeding Risk: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:135. [PMID: 37103014 PMCID: PMC10144375 DOI: 10.3390/jcdd10040135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 04/28/2023] Open
Abstract
Cardiovascular (CV) events in patients with cancer can be caused by concomitant CV risk factors, cancer itself, and anticancer therapy. Since malignancy can dysregulate the hemostatic system, predisposing cancer patients to both thrombosis and hemorrhage, the administration of dual antiplatelet therapy (DAPT) to patients with cancer who suffer from acute coronary syndrome (ACS) or undergo percutaneous coronary intervention (PCI) is a clinical challenge to cardiologists. Apart from PCI and ACS, other structural interventions, such as TAVR, PFO-ASD closure, and LAA occlusion, and non-cardiac diseases, such as PAD and CVAs, may require DAPT. The aim of the present review is to review the current literature on the optimal antiplatelet therapy and duration of DAPT for oncologic patients, in order to reduce both the ischemic and bleeding risk in this high-risk population.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (A.V.); (A.A.); (N.V.-B.); (E.-E.K.); (G.V.); (P.D.)
| | - Angeliki Vakka
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (A.V.); (A.A.); (N.V.-B.); (E.-E.K.); (G.V.); (P.D.)
| | - Anastasios Apostolos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (A.V.); (A.A.); (N.V.-B.); (E.-E.K.); (G.V.); (P.D.)
- First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Eleni Bousoula
- Department of Cardiology, Tzaneio General Hospital, 185 36 Piraeus, Greece;
| | - Nikolaos Vythoulkas-Biotis
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (A.V.); (A.A.); (N.V.-B.); (E.-E.K.); (G.V.); (P.D.)
| | - Eleni-Evangelia Koufou
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (A.V.); (A.A.); (N.V.-B.); (E.-E.K.); (G.V.); (P.D.)
| | - Georgios Vasilagkos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (A.V.); (A.A.); (N.V.-B.); (E.-E.K.); (G.V.); (P.D.)
| | - Ioannis Tsiafoutis
- First Department of Cardiology, Red Cross Hospital, 115 26 Athens, Greece;
| | - Michalis Hamilos
- Department of Cardiology, Heraklion University Hospital, 715 00 Heraklion, Crete, Greece;
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, 6042 Charleroi, Belgium;
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece; (A.V.); (A.A.); (N.V.-B.); (E.-E.K.); (G.V.); (P.D.)
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