Abstract Body (Do not enter title and authors here): Background: Antiplatelets are important in ischemic heart disease(IHD) patients. We aim to research the efficacy and safety of single(SAPT), dual(DAPT), and triple(TAPT) antiplatelet approaches in IHD patients undergoing PCI.
Methods:A systematic review was conducted until April 1st, 2024, and a network meta-analysis using the Netmeta package in R studio 4.3.3 was performed. Primary outcomes were cardiac death, myocardial infarction(MI), stent thrombosis, stroke, and major bleeding(BARC 3-5). A sensitivity analysis was done to explain variables with high heterogeneity.
Results: From 25 studies, a total of 65115 patients were included in the analysis. For cardiac death, 17 studies showed TAPT had a lower risk than DAPT compared to SAPT [RR = 0.74; 95%CI (0.40 to 1.35); p-value = 0.33], [RR = 1.01, 95%CI (0.84 to 1.19); p-value = 0.87] respectively. The heterogeneity was insignificant(I2=0%; p-value=0.58. For MI, 23 studies found TAPT had a lower risk than DAPT compared to SAPT [RR = 0.77; 95%CI (0.51 to 1.16); p-value = 0.2047], [RR = 0.81, 95%CI (0.64 to 1.03); p-value = 0.0850] respectively. The heterogeneity was significant (I2 = 53%). For stent thrombosis, 17 studies showed DAPT had a lower risk than TAPT compared to SAPT [RR = 0.74; 95%CI (0.45 to 1.21); p-value = 0.2284], [RR = 0.84, 95%CI (0.27 to 2.59); p-value = 0.7630] respectively. The heterogeneity in this comparison was significant. For stroke, 17 studies showed DAPT had a lower risk than TAPT for stroke in comparison to SAPT [RR = 0.91; 95%CI (0.75 to 1.10); p-value = 0.3209], and [RR = 0.87, 95%CI (0.43 to 1.76); p-value=0.6937], respectively. The heterogeneity was insignificant(I2=0%; p-value=0.8165). For Major bleeding(BARC 3-5), 15 studies showed DAPT had a lower risk than TAPT in comparison to SAPT[RR = 1.43; 95%CI (1.09 to 1.88); p-value = 0.0107], [RR = 2.78, 95%CI (0.90 to 4.78); p-value = 0.0852] respectively. The heterogeneity was significant(I2 = 49.5%).
Conclusion: Personalized treatment approaches that consider the benefits and risks of different antiplatelet strategies are crucial for optimal patient management of IHD.