{"id":"e1142dcda9b1","type":"article","url":"https://hartvaat.nl/2026/01/30/off-label-lage-dosis-bloedplaatjesremmers-bij-coronairlijden-minder-infarcten-en/","title":"Off-label lage dosis bloedplaatjesremmers bij coronairlijden: minder infarcten en bloedingen (vooral Aziatische data)","title_en":"Efficacy and safety of off-label low-dose compared with standard-dose antiplatelet agents in patients with coronary heart disease: a meta-analysis","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["bloeddrukbehandeling"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003839?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003839?rss=1","authors":["Zheng","L.","Ren","Z.","Shi","Y.","Zou","J.","Hao","C.","Li","Y.","Sun","L.","Wang","D.","Liu","H.","Liang","S.","Zhu","B.","Li","C."],"significance":5,"published":"2026-01-30","source_date":"2026-01-30","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/"],"congress":"","summary_en":"This meta-analysis compared off-label low-dose with standard-dose antiplatelet agents in coronary heart disease (CHD), focusing on the gap around low- versus standard-dose ticagrelor and prasugrel. Twenty-two randomised trials (7,486 patients, 92% Asian; 64% exclusively acute coronary syndrome) were included, all using dual antiplatelet therapy (aspirin plus a low or standard dose P2Y12 inhibitor). Compared with standard dose, low dose reduced the risk of myocardial infarction (RR 0.75) and minimal bleeding (RR 0.64), with comparable other ischaemic and bleeding risks. Versus standard-dose clopidogrel, low dose reduced infarction but increased bleeding; versus standard-dose prasugrel/ticagrelor, ischaemic risks were similar with less bleeding. Low dose thus appears an effective secondary-prevention strategy, though the evidence rests mainly on Asian patients — in whom the ischaemia-bleeding balance differs from Europeans.","created":"2026-07-03T10:32:26Z","updated":"2026-07-03T13:31:23Z","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":"Deze meta-analyse vergeleek off-label lage doses met standaarddoses bloedplaatjesremmers bij coronairlijden (CHD), met aandacht voor de leemte rond lage versus standaarddosis ticagrelor en prasugrel. Er werden 22 gerandomiseerde trials (7.486 patiënten, 92% Aziatisch; 64% uitsluitend acuut coronair syndroom) ingesloten, met duale plaatjesremming (aspirine plus een lage of standaarddosis P2Y12-remmer). Vergeleken met de standaarddosis verlaagde een lage dosis het risico op een hartinfarct (RR 0,75) en op minimale bloedingen (RR 0,64), met vergelijkbare overige ischemische en bloedingsrisico's. Ten opzichte van standaarddosis clopidogrel verlaagde een lage dosis het infarctrisico maar verhoogde het de bloedingen; ten opzichte van standaarddosis prasugrel/ticagrelor waren de ischemische risico's gelijk met minder bloedingen. Een lage dosis lijkt dus een effectieve secundaire-preventiestrategie, al berust het bewijs vooral op Aziatische patiënten — bij wie de balans tussen ischemie en bloeding anders ligt dan bij Europeanen.","abstract_original":"Background\n

To compare the efficacy and safety of off-label low-dose versus standard-dose antiplatelet agents in coronary heart disease (CHD) patients, focusing on the evidence gap in comparisons of low-dose versus standard-dose ticagrelor and prasugrel.

\n\nMethods\n

PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, China National Knowledge Infrastructure and Wanfang databases were searched up to 11 May 2025 for randomised controlled trials. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. A meta-analysis was performed, with relative risk (RR) and 95% CI as the effect estimates. Subgroup analyses were performed stratified by antiplatelet agent type, ethnic region, treatment duration and CHD subtype.

\n\nResults\n

A total of 22 randomised controlled trials, involving 7486 patients, met the study criteria. Among them, 92.09% were Asian, and 63.63% of the included studies exclusively enrolled acute coronary syndrome patients. All patients received the dual antiplatelet therapy (aspirin combined with a low or standard dose of P2Y12 receptor antagonist), mainly with low-dose prasugrel and ticagrelor. Off-label low-dose antiplatelet agents significantly reduced myocardial infarction (MI) (RR 0.75, 95% CI 0.58 to 0.97) and minimal bleeding risks (RR 0.64, 95% CI 0.50 to 0.82) compared with standard doses, with comparable risks for other ischaemic and bleeding events. Compared with standard-dose clopidogrel, they significantly reduced MI risk (RR 0.71, 95% CI 0.54 to 0.93) but increased overall (RR 1.40, 95% CI 1.11 to 1.77) and minor bleeding risks (RR 1.86, 95% CI 1.02 to 3.38). Compared with standard-dose prasugrel or ticagrelor, they demonstrated comparable ischaemic risks and significantly reduced overall and minimal bleeding risks. All other subgroup analyses were consistent with the overall findings.

\n\nConclusion\n

Off-label low-dose antiplatelet therapy reduces the risks of MI and minimal bleeding. It surpassed standard-dose clopidogrel and offered lower bleeding risks than prasugrel or ticagrelor, thus representing an effective secondary prevention strategy for Asian CHD.

\n\nPROSPERO registration number\n

CRD42023438376.

\n"}