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Antithrombotic Treatments in Patients with Chronic Coronary Artery Disease or Peripheral Artery Disease: A Systematic Review of Randomised Controlled Trials.

Authors :
Bauersachs R
Wu O
Briere JB
Bowrin K
Borkowska K
Jakubowska A
Taieb V
Toumi M
Huelsebeck M
Source :
Cardiovascular therapeutics [Cardiovasc Ther] 2020 Jun 23; Vol. 2020, pp. 3057168. Date of Electronic Publication: 2020 Jun 23 (Print Publication: 2020).
Publication Year :
2020

Abstract

Aims: Acetylsalicylic acid (ASA) is widely used for the prevention of atherothrombotic events in patients with chronic coronary artery disease (CAD) and peripheral artery disease (PAD), but the risk of vascular events remains high. We aimed at identifying randomised controlled trials (RCTs) on antithrombotic treatments in patients with chronic CAD or PAD.<br />Methods: Searches were conducted on MEDLINE, EMBASE, and CENTRAL on March 1 <superscript>st</superscript> , 2018. This systematic review (SR) uses a narrative synthesis to summarize the evidence for the efficacy and safety of antiplatelet and anticoagulant therapies in the population of both chronic CAD or PAD patients.<br />Results: Four RCTs from 27 publications were included. Study groups included 15,603 to 27,395 patients. ASA alone was the most extensively studied ( n = 3); other studies included rivaroxaban with or without ASA ( n = 1), vorapaxar alone ( n = 1), and clopidogrel with ( n = 1) or without ASA ( n = 1). Clopidogrel alone and clopidogrel plus ASA compared to ASA presented similar efficacy with comparable safety profile. Rivaroxaban plus ASA significantly reduced the risk of the composite of cardiovascular death, myocardial infarction, and stroke compared to ASA alone, although major bleeding with rivaroxaban plus ASA increased.<br />Conclusion: There is limited and heterogeneous evidence on the prevention of atherothrombotic events in patients with chronic CAD or PAD. Clopidogrel alone and clopidogrel plus ASA did not demonstrate superiority over ASA alone. A combination of rivaroxaban plus ASA may offer significant additional benefit in reducing cardiovascular outcomes, yet it may increase the risk of bleeding, compared to ASA alone.<br />Competing Interests: RB has served as Principal Investigator on studies conducted by Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Daiichi-Sankyo, and Leo, and he has acted as a consultant and served on speakers' bureaus for Bayer, BMS, Boehringer Ingelheim, Daiichi-Sankyo, and Pfizer. KB is an employee of Bayer Plc; JBB and MH are employees of Bayer AG. KBO, AJ, and VT are employees of Creativ-Ceutical, who received funding from Bayer AG for the study conduction. MT is a consultant to Creativ-Ceutical. OW is a professor of Health Technology Assessment, University of Glasgow and has received payment for consultancy from Bayer. Bayer holds the trademark for acetylsalicylic acid in several countries, developed and markets rivaroxaban, and funded and oversaw the COMPASS trial; however, we are transparent in COIs; the purpose of this article was to review existing data. Study selection and extraction were carried out by Creativ-Ceutical, and Bayer employees had no effect on the results. All steps of the review were documented.<br /> (Copyright © 2020 Rupert Bauersachs et al.)

Details

Language :
English
ISSN :
1755-5922
Volume :
2020
Database :
MEDLINE
Journal :
Cardiovascular therapeutics
Publication Type :
Academic Journal
Accession number :
32695228
Full Text :
https://doi.org/10.1155/2020/3057168