Efficacy and safety of ticagrelor monotherapy in patients following percutaneous coronary intervention A systematic review and meta-analysis

Background: We aimed to systematically evaluate the efficacy and safety ticagrelor monotherapy following percutaneous coronary intervention. Methods: Online databases were searched for relevant studies (published between the years 2015 and 2020) comparing 1-month Dual antiplatelet therapy (DAPT) followed by 23-month ticagrelor monotherapy with 12-month DAPT followed by 12-month aspirin monotherapy following percutaneous coronary intervention. Primary outcomes assessed efficacy whereas secondary outcomes assessed safety. Odds ratios (OR) with 95% confidence intervals (CIs) based on a random effect model were calculated and the analysis was carried out by the RevMan 5.3 software. Results: Only 6 studies were selected for this meta-analytical research. The meta-analysis results: MI(OR:0.96, 95% CI:0.86-1.06, P = .40), stroke (OR:1.04, 95% CI: 0.87-1.25, P = .68), stent thrombosis (OR: 0.91,95% CI:0.76-1.10,P = .32),New-Q Wave (OR:0.85,95% CI: 0.72-1.00, P = .05), all cause death (OR:0.91, 95% CI: 0.87-0.96, P < .0001), death from cardiovascular (OR: 0.76, 95% CI: 0.58-0.99, P = .04), revascularization (OR: 0.93, 95% CI: 0.87-0.99, P = .03). Ticagrelor monotherapy was associated with a significantly lower rate of myocardial Infarction (MI), stroke, stent thrombosis, all cause death, death from cardiovascular and revascularization (OR:0.91,95% CI:0.87-0.96, P < .0001) when compared to DAPT. Besides, DAPT was associated with a significantly higher rate of BARC3 or 5 bleeding (OR:0.85, 95% CI: 0.68-1.06; P = .16) when compared to ticagrelor. When bleeding was further subdivided, minor or major bleeding was also significantly higher with DAPT (OR: 0.72, 95% CI: 0.41-1.27; P = .26). GUSTO moderate or severe bleeding was also significantly higher with DAPT (OR: 0.77, 95% CI: 0.39-1.52; P = .45). Conclusion: Ticagrelor monotherapy after short-term dual-antiplatelet therapy (DAPT) can optimize ischemic and bleeding risks. And, it can reduce the occurrence of events outcome (MI, revascularization, stroke, stent thrombosis).