Browsing by Author "Nagendra, Lakshmi"

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    Sequential Administration of Abbreviated Dual Antiplatelet Therapy and Ticagrelor Monotherapy versus Standard Dual Antiplatelet Therapy after Percutaneous Coronary Intervention: A Meta-Analysis
    (IJCP Group, 2024-12) Kishor, Kamal; Nagendra, Lakshmi; Bisht, Devendra; Mahajan, Kunal
    Background: Dual antiplatelet therapy (DAPT), consisting of aspirin, and a P2Y12 inhibitor, has been crucial for reducing ischemic events following percutaneous coronary intervention (PCI). However, the optimal duration of DAPT remains under investigation. Objective: This meta-analysis aims to compare the efficacy and safety of an abbreviated-duration DAPT (Abv-DAPT) regimen (ticagrelor plus aspirin for 1 month or less, followed by ticagrelor monotherapy) with a conventional long-term duration DAPT (L-DAPT) regimen (ticagrelor plus aspirin for 12 months) in patients who have undergone PCI. Methods: We systematically searched PubMed-MEDLINE, EMBASE, Scopus, and the Cochrane Central Registry of Controlled Trials for studies with cohorts of patients who had undergone PCI and received DAPT with ticagrelor and aspirin. We analyzed data from the ULTIMATE-DAPT, T-PASS, and GLOBAL-LEADERS trials. Efficacy outcomes for this analysis were all-cause mortality, myocardial infarction, stent thrombosis, and stroke. Safety outcomes were major bleeding. The efficacy and safety events in patients of the Abv-DAPT arm were compared with those of L-DAPT arms. Results: The consolidated population from three major trials included in the meta-analysis was 22,218, with a nearly equal distribution between the Abv-DAPT arm (N = 11,106) and L-DAPT arms (N = 11,112). Our analysis found no significant difference in the incidence of stroke (RR = 0.95 [0.70-1.29]; p = 0.76), myocardial infarction (RR = 1.15 [0.94-1.4]; p = 0.18), thrombosis (RR = 1.25 [0.86-1.83]; p = 0.25), and all-cause mortality (RR = 0.85 [0.68-1.07]; p = 0.16) between two arms. However, major bleeding events were less (RR = 0.52 [0.27-1.0]; p = 0.05) in the Abv-DAPT arm than in the L-DAPT arm. Conclusion: Ticagrelor-based monotherapy after 1 month of ticagrelor-based DAPT could reduce bleeding complications without compromising ischemic protection. PROSPERO Registration: (CRD42024536139 - https://www.crd.york.ac.uk/PROSPEROFILES/536139_STRATEGY_20240726.pdf)