EXTENDED DUAL ANTIPLATELET THERAPY UTILIZING P2Y12 INHIBITORS FOLLOWING ACS/PCI : AN EVALUATION OF ISCHEMIC ADVANTAGES VERSUS HEMORRHAGIC RISKS
DOI:
https://doi.org/10.31004/jkt.v6i4.52569Keywords:
dual antiplatelet therapy ( DAPT), P2Y12 Inhibitors, Acute Coronary Syndrome (ACS), Ischemic Events, Hemorrhagic RiskAbstract
Metodologi ini mencakup tinjauan sistematis komprehensif terhadap literatur sesuai dengan pedoman PRISMA (PROSPERO CRD420251239032), yang mencakup rentang waktu dari Januari 2015 hingga Agustus 2025. Sebanyak 12 studi ditemukan, termasuk 2 uji coba terkontrol secara acak dan 10 studi observasional, yang secara kolektif melibatkan 89.813 individu, dan telah diteliti. Temuan utama menunjukkan bahwa memperpanjang DAPT melewati batas satu tahun umumnya dikaitkan dengan penurunan kejadian iskemik, dibuktikan dengan Rasio Bahaya (HR) berkisar antara 0,52 hingga 0,68 dalam studi observasional skala besar, khususnya yang berfokus pada populasi Asia. Pada dasarnya, penurunan probabilitas kejadian iskemik yang diakui tidak secara konsisten berhubungan dengan peningkatan frekuensi komplikasi perdarahan mayor yang signifikan dalam segmen kohort yang lebih besar yang diteliti. Uji coba seperti STOPDAPT-2 menyoroti bahwa monoterapi clopidogrel, yang diberikan setelah pemberian DAPT singkat, menunjukkan non-inferioritas untuk hasil iskemik sambil mencapai pengurangan risiko perdarahan yang substansial (HR 0,46-0,57). Meskipun demikian, stratifikasi risiko individu yang cermat sangat penting, karena data dunia nyata juga menunjukkan potensi bahaya perdarahan pada populasi pasien yang tidak diseleksi. Akibatnya, keputusan mengenai agen P2Y12 untuk terapi yang diperpanjang harus dipandu oleh profil risiko iskemik dan perdarahan spesifik pasien, daripada hanya mengandalkan keunggulan intrinsik obat tertentu.References
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