IMR Press / RCM / Volume 23 / Issue 11 / DOI: 10.31083/j.rcm2311360
Open Access Systematic Review
De-Escalation Dual Antiplatelet Therapy Prevail over Potent P2Y12 Inhibitor Monotherapy in Patients with Acute Coronary Syndrome Undergone Percutaneous Coronary Intervention: A Network Meta-Analysis
Show Less
1 Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
2 Institute of Cardiovascular Diseases, Nanchang University, 330006 Nanchang, Jiangxi, China
*Correspondence: (Ren-Qiang Yang)
Academic Editors: Domenico D’Amario and Mattia Galli
Rev. Cardiovasc. Med. 2022, 23(11), 360;
Submitted: 26 May 2022 | Revised: 11 August 2022 | Accepted: 2 September 2022 | Published: 25 October 2022
(This article belongs to the Special Issue Antiplatelet Therapy in Cardiovascular Disease)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Dual antiplatelet therapy (DAPT) with potent P2Y12 inhibitor is the cornerstone of acute coronary syndrome (ACS) management. Balancing the effects of different strategies of antiplatelet therapy including DAPT de-escalation, potent P2Y12 inhibitor monotherapy, and conventional DAPT is a hot topic. Methods: A systematic search was conducted from the MEDLINE, PubMed, and Embase through October 2021 to identify various DAPT strategies in randomized controlled trials (RCTs) for treatment of ACS patients after undergoing PCI with drug-eluting stent (DES). The network meta-analysis was performed to investigate the net clinic benefit of the DAPT de-escalation, potent P2Y12 inhibitor monotherapy, as well as conventional DAPT. The primary outcome was net adverse clinical events, defined as a composite of major bleeding and cardiac death, myocardial infarction, stroke, stent thrombosis, or target-vessel revascularization. The secondary outcomes include major adverse cardiac events and trial-defined major or minor bleeding. Results: A total of 14 RCTs with 63,982 patients were included. The DAPT de-escalation was associated with a lower risk of the primary outcome compared with potent P2Y12 inhibitor monotherapy (De-escalation vs monotherapy odds ratio (OR): 0.72 95% confidence interval (CI): 0.55–0.96), and other antiplatelet strategies (De-escalation vs clopidogrel + aspirin OR: 0.49 95% CI: 0.39–0.63; De-escalation vs prasugrel + aspirin OR: 0.76 95% CI: 0.59–0.98; De-escalation vs ticagrelor + aspirin OR: 0.76 95% CI: 0.55–0.90). There were no statistical differences in the incidence of bleeding (DAPT de-escalation vs P2Y12 inhibitor monotherapy OR: 0.73 95% CI: 0.47–1.12) and major adverse cardiac events (DAPT de-escalation vs P2Y12 inhibitor monotherapy OR: 0.79 95% CI: 0.59–1.08) between DAPT de-escalation and potent P2Y12 inhibitor monotherapy. Conclusions: This network meta-analysis showed that DAPT de-escalation would reduce the net adverse clinical events, compared with potent P2Y12 inhibitor monotherapy, for ACS patients undergone PCI treatment.

dual antiplatelet therapy
acute coronary syndrome
No. 81960081/National Natural Science Foundation of China
Fig. 1.
Back to top