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

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 the risk of major bleeding. 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 descalation 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.