Short DAPT reduced MACE in females (HR 0.86) but not males, while reducing major bleeding in males (HR 0.60) but not females, showing sex-specific benefits.
Do dual antiplatelet therapy de-escalation strategies have different effects on MACE and major bleeding in male versus female patients undergoing percutaneous coronary intervention?
Sex significantly influences the safety and efficacy of DAPT de-escalation after PCI, suggesting aspirin discontinuation is optimal for women while switching to clopidogrel is most effective for men.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background and aims Strategies of de-escalation of dual antiplatelet therapy (DAPT) improve outcomes after percutaneous coronary intervention compared to standard DAPT. However, the potential impact of sex on the safety and efficacy of these strategies is yet to be fully investigated. Methods Randomized controlled trials comparing de-escalated vs. standard DAPT regimens reporting outcomes by sex were included. The co-primary endpoints were trial-defined major adverse cardiovascular events (MACE) and major bleeding. Hazard ratios (HR) with 95% confidence intervals (CI) were computed to account for different follow-up durations. A network meta-analysis including ranking of treatments were performed to explore the comparative effects of different DAPT de-escalation strategies among female and male. Results 71,272 patients from twenty trials were included, 23.3% were females. De-escalation strategies were grouped into: 1) short DAPT, by discontinuation of aspirin or the P2Y12 inhibitor; or 2) mitigated P2Y12 inhibition, by switch or dose reduction. A significant interaction between treatment effect and sex with short vs. standard DAPT was found for both MACE (pint=0.028) and major bleeding (pint=0.015). Indeed, short DAPT reduced MACE in females (HR 0.86 95% CI 0.75–0.98) but not in males (HR 1.04 95% CI 0.93–1.16), while reduced major bleeding in males (HR 0.60; 95% CI 0.44–0.82) but not females (HR 1.04; 95% CI 0.76–1.43), compared to standard DAPT. Conversely, no interactions were found for mitigated P2Y12 inhibition vs. standard DAPT for both MACE (pint=0.668) and major bleeding (pint=0.963). At ranking of treatments, short DAPT with aspirin discontinuation ranked as the best treatment for most outcomes in females, while mitigated P2Y12 inhibition by switching to clopidogrel showed the best outcomes in males. Conclusions Sex significantly influences the safety and efficacy of antiplatelet de-escalation strategies, particularly those involving the shortening of DAPT. Aspirin discontinuation emerged as the optimal strategy for women, while mitigation of P2Y12 inhibition by switching to clopidogrel proved most effective for male patients.
Occhipinti et al. (Sat,) reported a other. Short DAPT reduced MACE in females (HR 0.86) but not males, while reducing major bleeding in males (HR 0.60) but not females, showing sex-specific benefits.
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