Summary

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• This summary is based on the review of 65 systematic review(s)/meta-analysis(es). ^[1-65]
• Major Adverse Cardiac and Cerebrovascular Events (MACCE): A 1-month dual antiplatelet therapy (DAPT) followed by P2Y12 inhibitors showed no difference in MACCE compared to 12 months of DAPT (relative risk (RR), 1.00; 95% credible interval (CrI), 0.70-1.41), while a 3-month DAPT followed by P2Y12 inhibitors ranked optimal for reducing MACCE (RR, 0.85; 95% CrI, 0.56-1.21). Clopidogrel compared to aspirin monotherapy was associated with a 28% reduction in major adverse cardiovascular events (MACE) (hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.54-0.98).
• Stroke: Aspirin plus clopidogrel reduced the risk of ischemic stroke by 28% compared to aspirin monotherapy (RR, 0.72; 95% CI, 0.65-0.80). Ticagrelor also showed a reduced stroke risk compared to clopidogrel (RR, 0.64; 95% CI, 0.42-0.98).
• Mortality: No significant difference in all-cause mortality was observed between clopidogrel and aspirin monotherapy (RR, 0.87; 95% CI, 0.53-1.41). However, ticagrelor reduced all-cause mortality compared to clopidogrel (HR, 0.85; 95% CI, 0.75-0.97).
• Safety - Major Bleeding: One-month DAPT followed by P2Y12 inhibitors reduced major bleeding relative to 12 months of DAPT (RR, 0.47; 95% CrI, 0.26-0.74). In contrast, ticagrelor, compared to clopidogrel, was associated with a higher risk of major bleeding (HR, 1.21; 95% CI, 1.02-1.44).
• Clopidogrel vs. Aspirin Monotherapy: No significant difference in clinically relevant bleeding (HR, 0.92; 95% CI, 0.68-1.24).
• Aspirin plus Clopidogrel vs. Aspirin Monotherapy: Increased risk of moderate or severe bleeding (RR, 1.88; 95% CI, 1.10-3.23).
• Acute Coronary Syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) demonstrated a reduction in major bleeding with 1-month DAPT followed by P2Y12 inhibitors, while post-PCI ACS patients showed a reduction in MACE with clopidogrel vs. aspirin monotherapy; a de-escalation strategy effectively reduced bleeding without increasing thrombotic events in ACS patients.
• In elderly ACS patients, ticagrelor reduced all-cause and cardiovascular mortality but increased bleeding risk; in Chronic Kidney Disease (CKD) patients, antiplatelet therapy reduced myocardial infarction but raised major bleeding risks.