CC BY-NC-ND 4.0 · Thromb Haemost 2023; 123(01): 108-117
DOI: 10.1055/s-0042-1757405
Atherosclerosis and Ischaemic Disease

Mortality of Escalation and Modulation Antithrombotic Therapy in Coronary Artery Disease Patients: A Meta-analysis of Randomized Controlled Trials

Qiao-Yu Shao
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Zhi-Jian Wang
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Xiao-Teng Ma
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Yu-Fei Wang
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Qiu-Xuan Li
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Zhi Qiang Yang
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Xu-Ze Lin
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Liu Pan
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Fei Gao
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Li Xia Yang
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Jing Liang
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
,
Yu-Jie Zhou
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
› Author Affiliations
Funding This project was funded by the National Key Research and Development Program of China (2017YFC0908800, to Yu-Jie Zhou), the Beijing Municipal Administration of Hospitals' Mission plan (SML20180601, to Yu-Jie Zhou), the China Postdoctoral Science Foundation (2021M692253, to Xiao-Teng Ma), the Beijing Postdoctoral Research Foundation (2021-ZZ-023, to Xiao-Teng Ma), the National Natural Science Foundation of China (81670391, to Zhi-Jian Wang).


Abstract

Background The net clinical benefit of antithrombotic therapy (ATT) reflects the concomitant effects of bleeding and ischemic events.

Objectives We sought to assess the overall effect of the modulation or escalation of ATT on all-cause mortality as well as ischemic and bleeding events.

Methods We performed a meta-analysis of randomized controlled trials comparing escalation or modulation of ATT versus standard ATT in patients with coronary artery disease. A total of 32 studies with 160,659 subjects were enrolled in this analysis.

Results Neither escalation nor modulation of ATT has significant effect on all-cause mortality (escalation: relative risk [RR]: 0.94, 95% confidence interval [CI]: 0.85–1.04; modulation: RR: 0.90; 95% CI: 0.81–1.01). Compared with standard ATT therapy, escalation of ATT was associated with lower risk of myocardial infarction (MI; RR: 0.84, 95% CI: 0.76–0.94), but had a higher risk of major or minor bleeding (RR: 1.38, 95% CI: 1.15–1.66). Modulation of ATT was associated with a similar risk of MI (RR: 1.07, 95% CI: 0.96–1.19), but a reduced risk for major or minor bleeding (RR: 0.58, 95% CI: 0.51–0.66). Meta-regression combining both escalation and modulation studies found that the heterogeneity of all-cause mortality was mainly attributed to the heterogeneity of major or minor bleeding (adjusted R-squared = 100.00%, p = 0.004), but not to MI.

Conclusion Either escalation or modulation of ATT has little benefit in all-cause mortality. The variability of the treatment effects on all-cause mortality was mainly attributed to the variability of major or minor bleeding, but not to MI.

Authors' Contributions

All authors contributed to study concept and design; Q.Y.S. and X.T.M. contributed to acquisition of data; Z.J.W. and Q.Y.S. did the statistical analysis; Q.Y.S. drafted the report; Z.J.W. contributed to critical revision of the manuscript for important intellectual content. All authors read and approved the final draft of the manuscript.


Ethics Committee Approval

This study was approved by the institutional review board of Beijing Anzhen Hospital, Capital Medical University.


Supplementary Material



Publication History

Received: 03 March 2022

Accepted: 02 August 2022

Article published online:
07 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany