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Indobufen versus aspirin after percutaneous coronary intervention in elderly patients with acute coronary syndrome
Wenbo Dai1, Guanyu Mu1, Jiayi Ren1
1Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China.
Insights
Indobufen offers similar safety and effectiveness to aspirin for elderly patients with Acute Coronary Syndrome after PCI. This alternative antiplatelet therapy may reduce gastrointestinal symptoms in this population.
Area of Science:
- Cardiology
- Pharmacology
- Geriatric Medicine
Background:
- Antiplatelet therapy is crucial for elderly patients with Acute Coronary Syndrome (ACS) post-Percutaneous Coronary Intervention (PCI).
- Aspirin, a standard treatment, can cause gastrointestinal (GI) issues or allergic reactions in some elderly patients.
Purpose of the Study:
- To evaluate Indobufen's safety and efficacy as an aspirin alternative.
- To assess Indobufen in dual antiplatelet therapy (DAPT) with clopidogrel for elderly ACS patients post-PCI.
Main Methods:
- Single-center, retrospective study with propensity score matching.
- Compared Indobufen DAPT versus aspirin DAPT in elderly ACS patients (Jan 2019-May 2022).
- Primary endpoint: Net Adverse Clinical Event (NACE) at 1 year (mortality, stroke, MI, revascularization, BARC 2/3/5 bleeding).
Main Results:
- After matching, 306 patients were in each group (Indobufen vs. aspirin).
- No significant difference in 1-year NACE rates (19.9% vs. 18.6%, P=0.876).
- Indobufen group showed a lower incidence of upper GI symptoms.
Conclusions:
- Indobufen is a comparable alternative to aspirin in elderly ACS patients post-PCI.
- Indobufen demonstrates similar efficacy and safety profiles.
- Indobufen may offer a benefit by reducing GI symptoms.
Background:
Antiplatelet therapy is pivotal in managing elderly patients with Acute Coronary Syndrome (ACS) following Percutaneous Coronary Intervention (PCI). While aspirin remains a cornerstone of this therapy, its use is sometimes limited by the risk of gastrointestinal (GI) complications or allergic reactions in certain patients.
Purpose:
This study aims to assess the safety and efficacy of Indobufen as an alternative to aspirin when used in combination with clopidogrel in elderly ACS patients post-PCI.
Methods:
This is a single-center, retrospective study employing propensity score matching. Elderly ACS patients who underwent PCI between January 2019 and May 2022 were enrolled. Participant were categorized into two groups based on their medication regimen: the aspirin DAPT group and the indobufen DAPT group. The primary endpoint was the Net Adverse Clinical Event (NACE) at 1 year, which included all-cause mortality, stroke, myocardial infarction (MI), target lesion revascularisation, and bleeding events classified under the Bleeding Academic Research Consortium (BARC) criteria type 2, 3, or 5.
Results:
A total of 2087 patients were enrolled in this study. Based on their medication regimen, 348 patients were assigned to indobufen DAPT group, while 1739 individuals were assigned to aspirin DAPT group. After applying 1:1 propensity score matching, 306 patients were included in each group. During the 1-year follow-up, the NACE occurred in 59 patients (19.9%) of the Indobufen DAPT group and 58 patients (18.6%) in the aspirin DAPT group, with no significant difference between the groups (HR 1.029, 95% CI 0.714-1.484, P = 0.876). Additionally, there were no significant difference in Patient-Oriented Composite Endpoint (POCE) and BARC 2, 3, or 5 bleeding events between the groups at 1, 3, or 6 months of follow-up. However, the indobufen DAPT group experienced a lower incidence of upper GI symptoms compared to the aspirin DAPT group.
Conclusion:
Indobufen, as an alternative to aspirin, demonstrates comparable efficacy and safety in elderly ACS patients after PCI, with a potential reduction in gastrointestinal symptoms. These findings support the use of indobufen as a viable alternative for elderly ACS patients who are intolerant to aspirin.
Clinical Trial Number:
Not applicable.
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