Dual antiplatelet therapy in GI-bleed patients with extensive coronary artery disease history: a systematic review

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Dual antiplatelet therapy (DAPT) is a cornerstone in managing extensive coronary artery disease, both initially and post-percutaneous coronary intervention (PCI).
• Clinicians face a critical balance between preventing thrombotic events and managing bleeding risks associated with DAPT.
• Understanding regional variations in bleeding predictors is essential for optimizing patient care.

Purpose of the Study:

• To systematically review existing literature on DAPT use in extensive coronary artery disease.
• To identify predictors of gastrointestinal (GI) bleeding in patients undergoing DAPT, with a focus on Southeast Asia.
• To evaluate the utility of bleeding risk prediction models in this patient population.

Main Methods:

• A systematic review of 39 papers, primarily from Southeast Asia, was conducted using electronic databases.
• Included studies encompassed randomized controlled trials (RCTs) and observational studies.
• Analysis focused on percutaneous coronary intervention (PCI) with drug-eluting stents as a common treatment modality.

Main Results:

• Drug-eluting stent PCI was the predominant treatment for acute coronary syndrome in the reviewed studies.
• Independent predictors of GI bleeding were identified in young and elderly patients from Southeast Asia.
• The precise DAPT score emerged as a frequently utilized bleeding risk prediction model.

Conclusions:

• Despite extensive research, clear strategies for managing the DAPT bleeding risk versus cardiac event risk in extensive coronary artery disease, particularly in Southeast Asia, are lacking.
• Further high-quality studies with robust statistical analysis and the development of clinical prediction rules are necessary.
• Addressing this knowledge gap is crucial for optimizing DAPT management in Southeast Asia and the Middle East.