Efficacy and safety of antiplatelet therapy after percutaneous coronary drug-eluting stenting: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LUO Lin ¹ , DING Xuefeng ² , FU Xiangzhen ¹ , LIU Kui ¹ ,  CHEN Li ²

1. Graduate School of North Sichuan Medical College, Nanchong 637000, P.R.China;
2. Department of Critical Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, P.R.China;

Corresponding author：

CHEN Li, Email: 493322386@qq.com

Keywords：

Percutaneous coronary intervention; Drug-eluting stents; Antiplatelet; Efficacy; Safety; Randomized controlled trial; Network meta-analysis

DOI：

10.7507/1672-2531.202004141

Video：

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Objectives To evaluate the efficacy and safety of four antiplatelet regimens after coronary drug-eluting stents by network meta-analysis.Methods PubMed, The Cochrane Library, EMbase and Web of Science databases were electronically searched to collect randomized controlled trials (RCTs) of the comparison of different antiplatelet regimens after coronary drug-eluting stenting from inception to December 31^st, 2019. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Network meta-analysis was then performed by using Gemtc14.3 software, Stata16.0 software and RevMan5.3 software.Results A total of 23 RCTs involving 45 837 patients were included. The results of network meta-analysis showed that: in terms of prevention of myocardial infarction (MI) recurrence, the aspirin monotherapy after short-term dual antiplatelet therapy was inferior to the triple antiplatelet therapy (OR=2.13, 95%CI 1.08 to 4.03). In terms of reducing the incidence of ischemic compound events, the triple antiplatelet therapy was superior to the standard dual antiplatelet therapy (OR=0.53, 95%CI 0.39 to 0.72), the aspirin monotherapy after short-term dual antiplatelet therapy (OR=0.49, 95%CI 0.35 to 0.69) and the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy (OR=0.51, 95%CI 0.35 to 0.73). There was no statistically significant difference among the four interventions in reducing the rate of in-stent thrombosis and all-cause mortality (P>0.05). In terms of safety, the bleeding rate of aspirin monotherapy after short-term dual antiplatelet therapy was lower than that of standard dual antiplatelet therapy (OR=0.70, 95%CI 0.55 to 0.86) and triple antiplatelet therapy (OR=0.58, 95%CI 0.36 to 0.90), and the bleeding rate of P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy was also lower than that of standard dual antiplatelet therapy (OR=0.51, 95%CI 0.39 to 0.65) and triple antiplatelet therapy (OR=0.43, 95%CI 0.26 to 0.67). The probability ranking diagram showed that: in terms of the recurrence rate of MI, the rate of in-stent thrombosis and the incidence of ischemic compound events, triple antiplatelet therapy was the lowest and aspirin monotherapy after short-term dual antiplatelet therapy was the highest. However, in terms of all-cause mortality and bleeding rate, aspirin or P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy was the lowest and triple antiplatelet therapy was the highest.Conclusions The available evidence suggests that when the risk of ischemia is low, we should choose aspirin or P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy, and P2Y12 inhibitor monotherapy may have a lower risk of ischemia and bleeding. When the risk of ischemia is high and bleeding is low, the triple or standard dual antiplatelet therapy should be selected, and the efficacy of triple antiplatelet therapy is superior, while the safety may be inferior.

Citation： LUO Lin, DING Xuefeng, FU Xiangzhen, LIU Kui, CHEN Li. Efficacy and safety of antiplatelet therapy after percutaneous coronary drug-eluting stenting: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(12): 1403-1412. doi: 10.7507/1672-2531.202004141 Copy

1.	Armstrong EJ, Feldman DN, Wang TY, et al. Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. JACC Cardiovasc Interv, 2012, 5(2): 131-140.
2.	Holmes DR, Kereiakes DJ, Garg S, et al. Stent thrombosis. J Am Coll Cardiol, 2010, 56(17): 1357-1365.
3.	Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med, 2007, 357(20): 2001-2015.
4.	Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med, 2009, 361(11): 1045-1057.
5.	Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol, 2016, 68(10): 1082-1115.
6.	Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J, 2018, 39(3): 213-260.
7.	Capodanno D, Mehran R, Valgimigli M, et al. Aspirin-free strategies in cardiovascular disease and cardioembolic stroke prevention. Nat Rev Cardiol, 2018, 15(8): 480-496.
8.	Fan ZG, Ding GB, Li XB, et al. The clinical outcomes of triple antiplatelet therapy versus dual antiplatelet therapy for high-risk patients after coronary stent implantation: a meta-analysis of 11 clinical trials and 9 553 patients. Drug Des Devel Ther, 2016, 10: 3435-3448.
9.	Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. Circulation, 2011, 123(23): 2736-2747.
10.	Bovill EG, Terrin ML, Stump DC, et al. Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI), Phase II Trial. Ann Intern Med, 1991, 115(4): 256-265.
11.	Schulz-Schüpke S, Byrne RA, Ten Berg JM, et al. ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. Eur Heart J, 2015, 36(20): 1252-1263.
12.	Lee BK, Kim JS, Lee OH, et al. Safety of six-month dual antiplatelet therapy after second-generation drug-eluting stent implantation: OPTIMA-C randomised clinical trial and OCT substudy. EuroIntervention, 2018, 13(16): 1923-1930.
13.	Kim BK, Hong MK, Shin DH, et al. A new strategy for discontinuation of dual antiplatelet therapy: The RESET Trial (REal Safety and Efficacy of 3-month Dual Antiplatelet Therapy Following Endeavor Zotarolimus-Eluting Stent Implantation). J Am Coll Cardiol, 2012, 60(15): 1340-1348.
14.	Hong SJ, Shin DH, Kim JS, et al. 6-month versus 12-month dual-antiplatelet therapy following long everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial. JACC Cardiovasc Interv, 2016, 9(14): 1438-1446.
15.	Han Y, Xu B, Xu K, et al. Six versus 12 months of dual antiplatelet therapy after implantation of biodegradable polymer sirolimus-eluting stent: randomized substudy of the I-LOVE-IT 2 Trial. Circ Cardiovasc Interv, 2016, 9(2): e003145.
16.	Hahn JY, Song YB, Oh JH, et al. 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial. Lancet, 2018, 391(10127): 1274-1284.
17.	Gwon HC, Hahn JY, Park KW, et al. Six-month versus 12-month dual antiplatelet therapy after implantation of drug-eluting stents: the efficacy of xience/promus versus cypher to reduce late loss after stenting (EXCELLENT) randomized, multicenter study. Circulation, 2012, 125(3): 505-513.
18.	Feres F, Costa RA, Abizaid A, et al. Three vs. twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA, 2013, 310(23): 2510-2522.
19.	Gilard M, Barragan P, Noryani AAL, et al. 6- versus 24-month dual antiplatelet therapy after implantation of drug-eluting stents in patients nonresistant to aspirin: the randomized, multicenter ITALIC trial. J Am Coll Cardiol, 2015, 65(8): 777-786.
20.	Colombo A, Chieffo A, Frasheri A, et al. Second-generation drug-eluting stent implantation followed by 6- versus 12-month dual antiplatelet therapy: the SECURITY randomized clinical trial. J Am Coll Cardiol, 2014, 64(20): 2086-2097.
21.	Mehran R, Baber U, Sharma SK, et al. Ticagrelor with or without aspirin in high-risk patients after PCI. N Engl J Med, 2019, 381(21): 2032-2042.
22.	Watanabe H, Domei T, Morimoto T, et al. Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: the STOPDAPT-2 randomized clinical trial. JAMA, 2019, 321(24): 2414-2427.
23.	Hahn JY, Song YB, Oh JH, et al. Effect of P2Y12 inhibitor monotherapy vs dual antiplatelet therapy on cardiovascular events in patients undergoing percutaneous coronary intervention: the SMART-CHOICE randomized clinical trial. JAMA, 2019, 321(24): 2428-2437.
24.	Tomaniak M, Chichareon P, Onuma Y, et al. Benefit and risks of aspirin in addition to ticagrelor in acute coronary syndromes: a post hoc analysis of the randomized GLOBAL LEADERS trial. JAMA Cardiol, 2019, 4(11): 1092-1101.
25.	Zuliani Mauro MF, Mangione JA, Costa JR, et al. Randomized angiographic and intravascular ultrasound comparison of dual-antiplatelet therapy vs. triple-antiplatelet therapy to reduce neointimal tissue proliferation in diabetic patients. J Invasive Cardiol, 2017, 29(3): 76-81.
26.	Zheng XT, Chen KY, Liu T, et al. Low-dose adjunctive cilostazol in patients with complex lesions undergoing percutaneous coronary intervention. Clin Exp Pharmacol Physiol, 2016, 43(1): 29-33.
27.	Youn YJ, Lee JW, Ahn SG, et al. Multicenter randomized trial of 3-month cilostazol use in addition to dual antiplatelet therapy after biolimus-eluting stent implantation for long or multivessel coronary artery disease. Am Heart J, 2014, 167(2): 241-248.
28.	Suh JW, Lee SP, Park KW, et al. Multicenter randomized trial evaluating the efficacy of cilostazol on ischemic vascular complications after drug-eluting stent implantation for coronary heart disease: results of the CILON-T (influence of cilostazol-based triple antiplatelet therapy on ischemic complication after drug-eluting stent implantation) trial. J Am Coll Cardiol, 2011, 57(3): 280-289.
29.	Lee SW, Park SW, Kim YH, et al. A randomized, double-blind, multicenter comparison study of triple antiplatelet therapy with dual antiplatelet therapy to reduce restenosis after drug-eluting stent implantation in long coronary lesions: results from the DECLARE-LONG II (drug-eluting stenting followed by cilostazol treatment reduces late restenosis in patients with long coronary lesions) trial. J Am Coll Cardiol, 2011, 57(11): 1264-1270.
30.	Lee SW, Park SW, Kim YH, et al. Drug-eluting stenting followed by cilostazol treatment reduces late restenosis in patients with diabetes mellitus the DECLARE-DIABETES trial (a randomized comparison of triple antiplatelet therapy with dual antiplatelet therapy after drug-eluting stent implantation in diabetic patients). J Am Coll Cardiol, 2008, 51(12): 1181-1187.
31.	Lee SW, Park SW, Kim YH, et al. Comparison of triple versus dual antiplatelet therapy after drug-eluting stent implantation (from the DECLARE-long trial). Am J Cardiol, 2007, 100(7): 1103-1108.
32.	Lee CH, Lee JY, Park GM, et al. Comparison of 1-year outcomes of triple (aspirin + clopidogrel + cilostazol) versus dual antiplatelet therapy (aspirin + clopidogrel + placebo) after implantation of second-generation drug-eluting stents into one or more coronary arteries: from the DECREASE-PCI trial. Am J Cardiol, 2018, 121(4): 423-429.
33.	Gao W, Zhang Q, Ge H, et al. Efficacy and safety of triple antiplatelet therapy in obese patients undergoing stent implantation. Angiology, 2013, 64(7): 554-558.
34.	郑利萍, 贾莉芳, 袁暾, 等. 新型可降解聚合物血管支架的体内血栓形成评价. 生物医学工程学杂志, 2019, 36(2): 232-237.
35.	席亚东, 黄玉华, 杜若林, 等. 血管内支架植入后的内皮损伤及其修复策略. 生物医学工程学杂志, 2018, 35(2): 307-313.
36.	Généreux P, Giustino G, Witzenbichler B, et al. Incidence, predictors, and impact of post-discharge bleeding after percutaneous coronary intervention. J Am Coll Cardiol, 2015, 66(9): 1036-1045.
37.	Eisenstein EL, Anstrom KJ, Kong DF, et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA, 2007, 297(2): 159-168.
38.	Gajulapalli RD, Dias S, Pattanshetty DJ, et al. Optimal duration of dual antiplatelet therapy after drug eluting stent implantation: a network meta-analysis. Anatol J Cardiol, 2017, 18(4): 251-260.
39.	Armstrong PC, Leadbeater PD, Chan MV, et al. In the presence of strong P2Y12 receptor blockade, aspirin provides little additional inhibition of platelet aggregation. J Thromb Haemost, 2011, 9(3): 552-561.
40.	Traby L, Kollars M, Kaider A, et al. Effects of P2Y12 receptor inhibition with or without aspirin on hemostatic system activation: a randomized trial in healthy subjects. J Thromb Haemost, 2016, 14(2): 273-281.
41.	Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet, 2004, 364(9431): 331-337.
42.	Vranckx P, Valgimigli M, Jüni P, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs. aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet, 2018, 392(10151): 940-949.
43.	Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA, 2005, 293(17): 2126-2130.
44.	Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet, 2007, 369(9562): 667-678.
45.	Park KW, Jeon KH, Kang SH, et al. Clinical outcomes of high on-treatment platelet reactivity in koreans receiving elective percutaneous coronary intervention (from results of the CROSS VERIFY study). Am J Cardiol, 2011, 108(11): 1556-1563.
46.	Tantry US, Bonello L, Aradi D, et al. Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol, 2013, 62(24): 2261-2273.
47.	Savi P, Zachayus JL, Delesque-Touchard N, et al. The active metabolite of clopidogrel disrupts P2Y12 receptor oligomers and partitions them out of lipid rafts. Proc Natl Acad Sci U S A, 2006, 103(29): 11069-11074.

1. Armstrong EJ, Feldman DN, Wang TY, et al. Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. JACC Cardiovasc Interv, 2012, 5(2): 131-140.
2. Holmes DR, Kereiakes DJ, Garg S, et al. Stent thrombosis. J Am Coll Cardiol, 2010, 56(17): 1357-1365.
3. Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med, 2007, 357(20): 2001-2015.
4. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med, 2009, 361(11): 1045-1057.
5. Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol, 2016, 68(10): 1082-1115.
6. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J, 2018, 39(3): 213-260.
7. Capodanno D, Mehran R, Valgimigli M, et al. Aspirin-free strategies in cardiovascular disease and cardioembolic stroke prevention. Nat Rev Cardiol, 2018, 15(8): 480-496.
8. Fan ZG, Ding GB, Li XB, et al. The clinical outcomes of triple antiplatelet therapy versus dual antiplatelet therapy for high-risk patients after coronary stent implantation: a meta-analysis of 11 clinical trials and 9 553 patients. Drug Des Devel Ther, 2016, 10: 3435-3448.
9. Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. Circulation, 2011, 123(23): 2736-2747.
10. Bovill EG, Terrin ML, Stump DC, et al. Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI), Phase II Trial. Ann Intern Med, 1991, 115(4): 256-265.
11. Schulz-Schüpke S, Byrne RA, Ten Berg JM, et al. ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. Eur Heart J, 2015, 36(20): 1252-1263.
12. Lee BK, Kim JS, Lee OH, et al. Safety of six-month dual antiplatelet therapy after second-generation drug-eluting stent implantation: OPTIMA-C randomised clinical trial and OCT substudy. EuroIntervention, 2018, 13(16): 1923-1930.
13. Kim BK, Hong MK, Shin DH, et al. A new strategy for discontinuation of dual antiplatelet therapy: The RESET Trial (REal Safety and Efficacy of 3-month Dual Antiplatelet Therapy Following Endeavor Zotarolimus-Eluting Stent Implantation). J Am Coll Cardiol, 2012, 60(15): 1340-1348.
14. Hong SJ, Shin DH, Kim JS, et al. 6-month versus 12-month dual-antiplatelet therapy following long everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial. JACC Cardiovasc Interv, 2016, 9(14): 1438-1446.
15. Han Y, Xu B, Xu K, et al. Six versus 12 months of dual antiplatelet therapy after implantation of biodegradable polymer sirolimus-eluting stent: randomized substudy of the I-LOVE-IT 2 Trial. Circ Cardiovasc Interv, 2016, 9(2): e003145.
16. Hahn JY, Song YB, Oh JH, et al. 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial. Lancet, 2018, 391(10127): 1274-1284.
17. Gwon HC, Hahn JY, Park KW, et al. Six-month versus 12-month dual antiplatelet therapy after implantation of drug-eluting stents: the efficacy of xience/promus versus cypher to reduce late loss after stenting (EXCELLENT) randomized, multicenter study. Circulation, 2012, 125(3): 505-513.
18. Feres F, Costa RA, Abizaid A, et al. Three vs. twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA, 2013, 310(23): 2510-2522.
19. Gilard M, Barragan P, Noryani AAL, et al. 6- versus 24-month dual antiplatelet therapy after implantation of drug-eluting stents in patients nonresistant to aspirin: the randomized, multicenter ITALIC trial. J Am Coll Cardiol, 2015, 65(8): 777-786.
20. Colombo A, Chieffo A, Frasheri A, et al. Second-generation drug-eluting stent implantation followed by 6- versus 12-month dual antiplatelet therapy: the SECURITY randomized clinical trial. J Am Coll Cardiol, 2014, 64(20): 2086-2097.
21. Mehran R, Baber U, Sharma SK, et al. Ticagrelor with or without aspirin in high-risk patients after PCI. N Engl J Med, 2019, 381(21): 2032-2042.
22. Watanabe H, Domei T, Morimoto T, et al. Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: the STOPDAPT-2 randomized clinical trial. JAMA, 2019, 321(24): 2414-2427.
23. Hahn JY, Song YB, Oh JH, et al. Effect of P2Y12 inhibitor monotherapy vs dual antiplatelet therapy on cardiovascular events in patients undergoing percutaneous coronary intervention: the SMART-CHOICE randomized clinical trial. JAMA, 2019, 321(24): 2428-2437.
24. Tomaniak M, Chichareon P, Onuma Y, et al. Benefit and risks of aspirin in addition to ticagrelor in acute coronary syndromes: a post hoc analysis of the randomized GLOBAL LEADERS trial. JAMA Cardiol, 2019, 4(11): 1092-1101.
25. Zuliani Mauro MF, Mangione JA, Costa JR, et al. Randomized angiographic and intravascular ultrasound comparison of dual-antiplatelet therapy vs. triple-antiplatelet therapy to reduce neointimal tissue proliferation in diabetic patients. J Invasive Cardiol, 2017, 29(3): 76-81.
26. Zheng XT, Chen KY, Liu T, et al. Low-dose adjunctive cilostazol in patients with complex lesions undergoing percutaneous coronary intervention. Clin Exp Pharmacol Physiol, 2016, 43(1): 29-33.
27. Youn YJ, Lee JW, Ahn SG, et al. Multicenter randomized trial of 3-month cilostazol use in addition to dual antiplatelet therapy after biolimus-eluting stent implantation for long or multivessel coronary artery disease. Am Heart J, 2014, 167(2): 241-248.
28. Suh JW, Lee SP, Park KW, et al. Multicenter randomized trial evaluating the efficacy of cilostazol on ischemic vascular complications after drug-eluting stent implantation for coronary heart disease: results of the CILON-T (influence of cilostazol-based triple antiplatelet therapy on ischemic complication after drug-eluting stent implantation) trial. J Am Coll Cardiol, 2011, 57(3): 280-289.
29. Lee SW, Park SW, Kim YH, et al. A randomized, double-blind, multicenter comparison study of triple antiplatelet therapy with dual antiplatelet therapy to reduce restenosis after drug-eluting stent implantation in long coronary lesions: results from the DECLARE-LONG II (drug-eluting stenting followed by cilostazol treatment reduces late restenosis in patients with long coronary lesions) trial. J Am Coll Cardiol, 2011, 57(11): 1264-1270.
30. Lee SW, Park SW, Kim YH, et al. Drug-eluting stenting followed by cilostazol treatment reduces late restenosis in patients with diabetes mellitus the DECLARE-DIABETES trial (a randomized comparison of triple antiplatelet therapy with dual antiplatelet therapy after drug-eluting stent implantation in diabetic patients). J Am Coll Cardiol, 2008, 51(12): 1181-1187.
31. Lee SW, Park SW, Kim YH, et al. Comparison of triple versus dual antiplatelet therapy after drug-eluting stent implantation (from the DECLARE-long trial). Am J Cardiol, 2007, 100(7): 1103-1108.
32. Lee CH, Lee JY, Park GM, et al. Comparison of 1-year outcomes of triple (aspirin + clopidogrel + cilostazol) versus dual antiplatelet therapy (aspirin + clopidogrel + placebo) after implantation of second-generation drug-eluting stents into one or more coronary arteries: from the DECREASE-PCI trial. Am J Cardiol, 2018, 121(4): 423-429.
33. Gao W, Zhang Q, Ge H, et al. Efficacy and safety of triple antiplatelet therapy in obese patients undergoing stent implantation. Angiology, 2013, 64(7): 554-558.
34. 郑利萍, 贾莉芳, 袁暾, 等. 新型可降解聚合物血管支架的体内血栓形成评价. 生物医学工程学杂志, 2019, 36(2): 232-237.
35. 席亚东, 黄玉华, 杜若林, 等. 血管内支架植入后的内皮损伤及其修复策略. 生物医学工程学杂志, 2018, 35(2): 307-313.
36. Généreux P, Giustino G, Witzenbichler B, et al. Incidence, predictors, and impact of post-discharge bleeding after percutaneous coronary intervention. J Am Coll Cardiol, 2015, 66(9): 1036-1045.
37. Eisenstein EL, Anstrom KJ, Kong DF, et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA, 2007, 297(2): 159-168.
38. Gajulapalli RD, Dias S, Pattanshetty DJ, et al. Optimal duration of dual antiplatelet therapy after drug eluting stent implantation: a network meta-analysis. Anatol J Cardiol, 2017, 18(4): 251-260.
39. Armstrong PC, Leadbeater PD, Chan MV, et al. In the presence of strong P2Y12 receptor blockade, aspirin provides little additional inhibition of platelet aggregation. J Thromb Haemost, 2011, 9(3): 552-561.
40. Traby L, Kollars M, Kaider A, et al. Effects of P2Y12 receptor inhibition with or without aspirin on hemostatic system activation: a randomized trial in healthy subjects. J Thromb Haemost, 2016, 14(2): 273-281.
41. Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet, 2004, 364(9431): 331-337.
42. Vranckx P, Valgimigli M, Jüni P, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs. aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet, 2018, 392(10151): 940-949.
43. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA, 2005, 293(17): 2126-2130.
44. Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet, 2007, 369(9562): 667-678.
45. Park KW, Jeon KH, Kang SH, et al. Clinical outcomes of high on-treatment platelet reactivity in koreans receiving elective percutaneous coronary intervention (from results of the CROSS VERIFY study). Am J Cardiol, 2011, 108(11): 1556-1563.
46. Tantry US, Bonello L, Aradi D, et al. Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol, 2013, 62(24): 2261-2273.
47. Savi P, Zachayus JL, Delesque-Touchard N, et al. The active metabolite of clopidogrel disrupts P2Y12 receptor oligomers and partitions them out of lipid rafts. Proc Natl Acad Sci U S A, 2006, 103(29): 11069-11074.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of antiplatelet therapy after percutaneous coronary drug-eluting stenting: a network meta-analysis

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