{"id":"e1881491beca","type":"article","url":"https://hartvaat.nl/2024/05/01/p2y12-monotherapie-versus-dapt-na-pci-ipd-meta-analyse/","title":"P2Y12-monotherapie versus DAPT na PCI: IPD meta-analyse","title_en":"Ticagrelor or Clopidogrel Monotherapy vs Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: A Systematic Review and Patient-Level Meta-Analysis.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["clopidogrel","dubbele-trombocytenremming"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.0133","source_url":"https://doi.org/10.1001/jamacardio.2024.0133","authors":["Marco Valgimigli","Felice Gragnano","Mattia Branca","Anna Franzone","Bruno R da Costa","Usman Baber","Takeshi Kimura","Yangsoo Jang","Joo-Yong Hahn","Qiang Zhao","Stephan Windecker","Charles M Gibson","Hirotoshi Watanabe","Byeong-Keuk Kim","Young Bin Song","Yunpeng Zhu","Pascal Vranckx","Shamir Mehta","Kenji Ando","Sung Jin Hong","Hyeon-Cheol Gwon","Patrick W Serruys","George D Dangas","Eùgene P McFadden","Dominick J Angiolillo","Dik Heg","Paolo Calabrò","Peter Jüni","Roxana Mehran"],"significance":8,"published":"2024-05-01","source_date":"2024-05-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/"],"congress":"","summary_en":"This patient-level meta-analysis confirmed that P2Y12 inhibitor monotherapy (ticagrelor or clopidogrel) after a short course of DAPT reduces major bleeding compared with standard 12-month DAPT without increasing ischemic events. The pooled evidence definitively supports de-escalation to single antiplatelet therapy.","created":"2026-07-03T10:30:54Z","updated":"2026-07-03T13:29:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Patiënt-niveau meta-analyse bevestigde dat P2Y12-monotherapie (ticagrelor of clopidogrel) na korte DAPT minder bloedingen geeft dan 12 maanden DAPT, zonder toename van ischemische events. De-escalatie naar monotherapie is veilig en effectief.","abstract_original":"IMPORTANCE: Among patients undergoing percutaneous coronary intervention (PCI), it remains unclear whether the treatment efficacy of P2Y12 inhibitor monotherapy after a short course of dual antiplatelet therapy (DAPT) depends on the type of P2Y12 inhibitor. OBJECTIVE: To assess the risks and benefits of ticagrelor monotherapy or clopidogrel monotherapy compared with standard DAPT after PCI. DATA SOURCES: MEDLINE, Embase, TCTMD, and the European Society of Cardiology website were searched from inception to September 10, 2023, without language restriction. STUDY SELECTION: Included studies were randomized clinical trials comparing P2Y12 inhibitor monotherapy with DAPT on adjudicated end points in patients without indication to oral anticoagulation undergoing PCI. DATA EXTRACTION AND SYNTHESIS: Patient-level data provided by each trial were synthesized into a pooled dataset and analyzed using a 1-step mixed-effects model. The study is reported following the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data. MAIN OUTCOMES AND MEASURES: The primary objective was to determine noninferiority of ticagrelor or clopidogrel monotherapy vs DAPT on the composite of death, myocardial infarction (MI), or stroke in the per-protocol analysis with a 1.15 margin for the hazard ratio (HR). Key secondary end points were major bleeding and net adverse clinical events (NACE), including the primary end point and major bleeding. RESULTS: Analyses included 6 randomized trials including 25 960 patients undergoing PCI, of whom 24 394 patients (12 403 patients receiving DAPT; 8292 patients receiving ticagrelor monotherapy; 3654 patients receiving clopidogrel monotherapy; 45 patients receiving prasugrel monotherapy) were retained in the per-protocol analysis. Trials of ticagrelor monotherapy were conducted in Asia, Europe, and North America; trials of clopidogrel monotherapy were all conducted in Asia. Ticagrelor was noninferior to DAPT for the primary end point (HR, 0.89; 95% CI, 0.74-1.06; P for noninferiority = .004), but clopidogrel was not noninferior (HR, 1.37; 95% CI, 1.01-1.87; P for noninferiority > .99), with this finding driven by noncardiovascular death. The risk of major bleeding was lower with both ticagrelor (HR, 0.47; 95% CI, 0.36-0.62; P < .001) and clopidogrel monotherapy (HR, 0.49; 95% CI, 0.30-0.81; P = .006; P for interaction = 0.88). NACE were lower with ticagrelor (HR, 0.74; 95% CI, 0.64-0.86, P < .001) but not with clopidogrel monotherapy (HR, 1.00; 95% CI, 0.78-1.28; P = .99; P for interaction = .04). CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis found that ticagrelor monotherapy was noninferior to DAPT for all-cause death, MI, or stroke and superior for major bleeding and NACE. Clopidogrel monotherapy was similarly associated with reduced bleeding but was not noninferior to DAPT for all-cause death, MI, or stroke, largely because of risk observed in 1 trial that exclusively included East Asian patients and a hazard that was driven by an excess of noncardiovascular death."}