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Sex-Based Outcomes of Dual-Antiplatelet Therapy After Percutaneous Coronary Intervention: A Pairwise and Network Meta-Analysis
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Sex-Based Outcomes of Dual-Antiplatelet Therapy After Percutaneous Coronary Intervention: A Pairwise and Network Meta-Analysis
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Journal Article
Sex-Based Outcomes of Dual-Antiplatelet Therapy After Percutaneous Coronary Intervention: A Pairwise and Network Meta-Analysis
2024
Overview
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 non-inferior 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.
Clinical Trials Registration
PROSPERO ID: CRD42021278663.
Graphical Abstract
Sex differences in outcomes of clinical trials of dual antiplatelet therapy (DAPT) after percutaneous coronary interventions (PCI).
Publisher
Springer International Publishing,Springer Nature B.V
Subject
/ Bias
/ Bleeding
/ Clopidogrel - administration & dosage
/ Clopidogrel - adverse effects
/ Clopidogrel - therapeutic use
/ CRD
/ Dual Anti-Platelet Therapy - methods
/ Female
/ Females
/ Hemorrhage - chemically induced
/ Humans
/ Ischemia
/ Male
/ Males
/ Medicine
/ Percutaneous Coronary Intervention - adverse effects
/ Platelet Aggregation Inhibitors - administration & dosage
/ Platelet Aggregation Inhibitors - adverse effects
/ Platelet Aggregation Inhibitors - therapeutic use
/ Stroke
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