Within and beyond 12-month efficacy and safety of antithrombotic strategies in patients with established coronary artery disease: two companion network meta-analyses of the 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association for Acute CardioVascular Care (ACVC), and European Association of Preventive Cardiology (EAPC)
Authors' conclusion
Within 12 months, ticagrelor 90 mg monotherapy was the only treatment associated with lower mortality, without bleeding risk trade-off compared with aspirin and clopidogrel. Beyond 12 months, P2Y12 monotherapy, especially ticagrelor 90 mg, was associated with lower MI without bleeding trade-off; aspirin and rivaroxaban 2.5 mg most effectively reduced stroke, with a more acceptable bleeding risk than VKA, compared with aspirin.
Study context
- Population
- Patients with established CAD within or after 12 months following coronary revascularization and/or ACS43 trials (N = 189,261) within
- Comparison
- Antithrombotic strategies within and beyond 12 months vs aspirin and clopidogrel (within) or aspirin (beyond)
- Outcome
- CV mortality
- Follow-up
- Within 12 months
Methodological detailstwo companion network meta-analyses
- Two companion network meta-analyses
Pooled result
As reported in the abstract
Each group vs aspirin + clopidogrelHazard ratio (95% CI)
Ticagrelor 90 mg
0.66(0.49–0.88)
Aspirin + ticagrelor 90 mg
0.85(0.76–0.95)
Aspirin + clopidogrel + rivaroxaban 2.5 mg
0.66(0.51–0.86)
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| MI · beyond 12 monthsAspirin + clopidogrel vs Aspirin | 0.68 (0.55–0.85) | |
| MI · beyond 12 monthsP2Y12 inhibitor monotherapy vs Aspirin | 0.76 (0.61–0.95) | |
| MI · beyond 12 monthsTicagrelor 90 mg vs Aspirin | 0.54 (0.32–0.92) | |
| Stroke · beyond 12 monthsVKA vs Aspirin | 0.56 (0.44–0.76) | |
| Stroke · beyond 12 monthsAspirin + rivaroxaban 2.5 mg vs Aspirin | 0.58 (0.44–0.76) | |
| 0.20.5125Hazard ratio (log scale) |
Mortality · beyond 12 months
- No strategy lowered mortality
Safety
Bleeding · beyond 12 months
- All treatments increased bleeding except P2Y12 monotherapy, vs aspirin
Original publication
Within and beyond 12-month efficacy and safety of antithrombotic strategies in patients with established coronary artery disease: two companion network meta-analyses of the 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association for Acute CardioVascular Care (ACVC), and European Association of Preventive Cardiology (EAPC). Eur Heart J Cardiovasc Pharmacother. Published 3 March 2023. doi:10.
Summarised from the published abstract; every number is checked against it