P2Y12 Inhibitors versus Aspirin Monotherapy for Long-term Secondary Prevention of Atherosclerotic Cardiovascular Disease Events: A Systematic Review and Meta-analysis |
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| Institution: | 1. Department of Medicine, University of Kentucky, KY;2. Department of Cardiology, Creighton University School of Medicine, NE;3. Department of Medicine, University of Toledo, Toledo, OH;4. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN;5. Department of Medicine, Mayo Clinic, Rochester, MN;6. Department of Cardiovascular Medicine, Case Western University (Metrohealth), Cleveland, OH;7. Department of Cardiovascular Medicine, University of Connecticut, Farmington, CT;8. Departments of Medicine, Cook County Hospital, Chicago, IL;9. Departments of Medicine, Yarmouk University, Irbid, Jordan;10. Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD;11. Division of Cardiovascular Medicine, University of Kentucky, KY;12. Department of Medical Education, University of Tennessee at Nashville, TN;1. Department of Internal Medicine, University of Kentucky, Lexington,KY;2. Department of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY;1. Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, School of Medicine, Baltimore, MD;2. Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD;3. Division of Cardiology, Duke University School of Medicine, Durham, NC;4. American College of Cardiology, Washington, DC;5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;6. Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI;7. Division of Cardiology, The Ohio State University, Columbus, OH;1. Division of Cardiology, Sanatorio Güemes, Buenos Aires city, Argentina;2. Division of Cardiology, Sanatorio de la Trinidad de Palermo, Buenos Aires city, Argentina;3. Division of Cardiology, Sanatorio Finochietto, Buenos Aires city, Argentina;4. Division of Cardiology, Durand Hospital, Buenos Aires city, Argentina;5. Division of interventional cardiology, Grupo Gamma, Rosario, Argentina;1. Doctoral studant Health Promotion Program from University of Franca;2. Medicine, Faculty Medicine from University of Franca;3. Social Medicine, Health Promotion Program from University of Franca, Departamento de Promoção de Saúde, Universidade de Franca, Av. Dr. Armando de Sáles Oliveira, Franca, SP, Brazil;1. Superior School of Medicine, National Polytechnic Institute, Mexico City, Mexico;2. Cardiothoracic Surgery Department, Hospital General de México “Dr Eduardo Liceaga”, Mexico City, Mexico;3. Directorate of Research, Hospital General de Mexico “Dr. Eduardo Liceaga,” Mexico City, Mexico;4. Faculty of Medicine, Benemerita Universidad Autonoma de Puebla, Puebla, Puebla;5. I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, Moscow, Russia;1. Department of Medicine, Reading Hospital, Tower Health, Reading, PA;2. Emkey Arthritis and Osteoporosis Clinic;3. Department of Medicine, AMITA Health Saint Francis Hospital, Evanston, IL, United States of America |
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| Abstract: | Patients with established atherosclerotic cardiovascular disease (ASCVD) need long-term antiplatelet therapy to decrease the risk of future ASCVD events. We searched PubMed, Cochrane Library, and ClinicalTrials.gov (inception through September 2021) for randomized controlled trials (RCTs) evaluating P2Y12 inhibitors vs aspirin for secondary prevention of ASCVD events. Seven RCTs including a total of 56,982 patients were included in this analysis. The median follow-up duration was 22.8 (IQR 12) months. When P2Y12 inhibitors were compared with aspirin as long-term antiplatelet therapy for secondary prevention of ASCVD events, there was a significant decrease in the risk of myocardial infarction RR: 0.83; 95% CI: 0.72-0.94], and stroke RR: 0.90; 95% CI: 0.83-0.99]. However, there was no significant difference in all-cause mortality RR: 1.02; 95% CI: 0.92-1.12], or cardiovascular mortality RR: 0.95; 95% CI: 0.83-1.08] between P2Y12 inhibitors and aspirin users. Additionally, there was no significant difference in major bleeding events RR: 0.88; 95% CI: 0.74-1.04], or all bleeding events RR: 1.09; 95% CI: 0.90-1.33] between P2Y12 inhibitors and aspirin groups. Use of P2Y12 inhibitor monotherapy is associated with lower rates of myocardial infarction and stroke in ASCVD patients without any significant difference in mortality, or bleeding compared to aspirin monotherapy. |
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