Vol. 51 | No. 2 | July-December 2023 Back

Open Access

Efficacy and Safety of Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After Percutaneous Coronary Intervention With Drug-Eluting Stent in Patients With Diabetes Mellitus: A Systematic Review and Meta- analysis

Billy Joseph David, Althea Nicole Tanedo, John Derrik Tee, Ferdinand R. Gerodias
Dec 2023 DOI 10.69944/pjc.ec1568914d

Abstract

BACKGROUND: Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the standard for the prevention of thrombotic events in patients undergoing percutaneous coronary intervention (PCI). Type 2 diabetes mellitus (DM) patients are a subgroup with a higher risk of bleeding and thrombotic events after PCI.
OBJECTIVES: This meta-analysis aimed to determine whether ticagrelor monotherapy after an initial short-course DAPT is an effective and safe option in preventing thrombotic events among DM patients undergoing PC.
METHODS: A systematic review and meta-analysis was done on randomized controlled trials (RCT) comparing ticagrelor monotherapy following short-course DAPT versus conventional DAPT in T2DM patients who underwent PCI. Outcome measures for major bleeding, myocardial infarction, and all-cause mortality were extracted and analyzed using a random-effects model via RevMan version 5.3.
RESULTS: A total of three RCTs, with 7482 patients, were analyzed. There were no significant differences in major bleeding (P = 0.26) and myocardial infarction (P = 0.66) events between the ticagrelor and DAPT groups. However, there was a higher rate of all-cause mortality in the DAPT group, which was statistically significant (risk ratio, 0.76; 95% confidence interval, 0.59–0.98; P = 0.03).
CONCLUSION: Ticagrelor monotherapy following short-course DAPT and conventional DAPT have similar rates of major bleeding and myocardial infarction among DM patients undergoing PCI with DES. However, conventional DAPT has a higher incidence of all-cause mortality, which suggests that ticagrelor monotherapy after short-course DAPT may be a preferable antiplatelet strategy in DM patients undergoing PCI.
KEYWORDS: bleeding, diabetes mellitus, dual-antiplatelet therapy, percutaneous coronary intervention, thrombosis, ticagrelor

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