Efficacy and safety of dual and triple antiplatelet therapies in East Asian patients with acute coronary syndrome: a systematic review and network meta-analysis of randomized controlled trials

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Abstract
This systematic review and network meta-analysis (NMA) evaluated the efficacy and safety of dual antiplatelet therapy (DAPT) and triple antiplatelet therapy (TAPT) in East Asian patients with acute coronary syndrome. Twenty-six randomized controlled trials comparing DAPT (P2Y12 inhibitor with aspirin) or TAPT (cilostazol with clopidogrel-based DAPT) were included from four databases. Primary outcomes were major adverse cardiac events (MACEs) and major bleeding events. Frequentist NMA was performed using RRs. The reference comparator was clopidogrel-based DAPT. TAPT significantly reduced MACEs without increasing major bleeding events. Standard-dose potent P2Y12 inhibitor-based DAPT showed no MACE reduction but significantly increased major bleeding events. TAPT had the highest probability of reducing MACEs, while DAPT incorporating potent P2Y12 inhibitors with de-escalation had the highest probability of minimizing major bleeding events. To conclude, TAPT demonstrates promising efficacy without compromising safety, while de-escalation strategies appear effective in balancing the efficacy and safety of DAPT.

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