Abstract Body (Do not enter title and authors here): Background
Various durations and de-escalation strategies of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention for patients presenting with acute coronary syndromes (ACS) have been reported in randomized controlled trials (RCTs). However, it remains uncertain whether the effect of these DAPT strategies is influenced by sex.
Methods
PubMed and EMBASE were searched in May 2024. We included RCTs which investigated DAPT strategies for ACS patients comparing any de-escalation strategies such as short-term DAPT (≤6 months) followed by P2Y₁₂ inhibitor or aspirin monotherapy, unguided de-escalation from potent P2Y₁₂ inhibitors to low-dose potent P2Y₁₂ inhibitors or clopidogrel at one month, and guided de-escalation with platelet function tests, compared with standard duration DAPT (6-12 months). We conducted a systematic review and meta-analysis. The efficacy and safety of each DAPT strategy was compared between sexes, and relative hazard ratios (RHR) were calculated. The primary outcome was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, and major bleeding (BARC 3 or 5).
Results
Eleven RCTs that enrolled 27,033 patients with ACS were included. De-escalation of antiplatelet therapy had a lower risk of NACE than standard duration DAPT for both female (HR, 0.73; 95% CI, 0.55-0.96; I²=32%) and male (HR, 0.85; 95% CI, 0.74-0.97; I²=23%). There were no significant differences in NACE between female and male patients randomized to de-escalation vs. standard duration DAPT (RHR, 0.84; 95% CI, 0.65-1.09 ; I²=0%) (Figure). Similarly, no significant differences were observed between female and male patients with respect to major adverse cardiovascular events (RHR, 0.75; 95% CI, 0.52-1.08; I²=0%) or major bleeding (RHR, 1.37; 95% CI, 0.85-2.21 ;I²=0%).
Conclusion
In patients with ACS, de-escalation of antiplatelet therapy is safe and effective irrespective of sex.