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Sex-Based Outcomes of Dual-Antiplatelet Therapy After Percutaneous Coronary Intervention: A Pairwise and Network Meta-Analysis

Agbaedeng, TA, Noubiap, JJ, Roberts, KA, Chew, DP, Psaltis, PJ and Amare, AT (2024) Sex-Based Outcomes of Dual-Antiplatelet Therapy After Percutaneous Coronary Intervention: A Pairwise and Network Meta-Analysis. Drugs. ISSN 0012-6667

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Sex based outcomes of dual antiplatelet therapy after percutaneous coronary intervention a pairwise and network metaanalysis.pdf - Accepted Version
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Background Although dual antiplatelet therapy (DAPT) improves the outcomes of patients undergoing percutaneous coronary intervention (PCI), sex-specific differences in efficacy and safety of DAPT remain unresolved. We compared sex differences for DAPT outcomes and DAPT durations (1–3 months [short-term], 6 months [mid-term], and >12 months [extended] vs. 12 months). Methods We searched databases through 31 December 2023 for trials reporting DAPT after PCI. The endpoints were major adverse cardiovascular and cerebrovascular events (MACCE), net adverse clinical and cerebrovascular events (NACCE), and any bleeding. Extracted data were pooled in a frequentist network and pairwise, random-effects meta-analysis. Results Twenty-two trials (99,591 participants, 25.2% female) were included. Female sex was significantly associated with a higher 1-year MACCE risk (hazard ratio 1.14 [95% confidence interval 1.02–1.28]) and bleeding (1.13 [1.00–1.28]), but not NACCE (1.12 [0.96–1.31]). In sub-analyses, the association between female sex and MACCE was related to use of clopidogrel as the second antiplatelet agent (1.11 [1.03–1.20]), whereas higher bleeding events were related to newer P2Y12 inhibitors (P2Y12i) (1.58 [1.01–2.46]). For DAPT duration, short-term DAPT followed by P2Y12i monotherapy was noninferior for MACCE in females and males (0.95 [95% CI 0.83–1.10; and 0.96 [0.80–1.16]) but tended to be superior in males for NACCE versus 12-month DAPT (0.96 [0.91–1.01]); mid-term DAPT tended to be associated with a lower bleeding risk in males (0.43 [0.17–1.09]). Conclusions Female sex is associated with higher MACCE and bleeding when newer P2Y12i agents are used. Short-term DAPT followed by P2Y12i monotherapy is safe and effective in both sexes undergoing PCI.

Item Type: Article
Additional Information: This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://doi.org/10.1007/s40265-024-02034-3
Uncontrolled Keywords: 1115 Pharmacology and Pharmaceutical Sciences; Pharmacology & Pharmacy
Subjects: R Medicine > RS Pharmacy and materia medica
Divisions: Sport & Exercise Sciences
Publisher: Springer
SWORD Depositor: A Symplectic
Date Deposited: 06 Jun 2024 09:41
Last Modified: 06 Jun 2024 09:45
DOI or ID number: 10.1007/s40265-024-02034-3
URI: https://researchonline.ljmu.ac.uk/id/eprint/23405
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