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Terapi jangka panjang antiplatelet ganda (≥ 12 bulan) pada acute coronary syndrome sebagai pencegah sekunder terhadap major adverse cardiac event : a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Long-term use of dual antiplatelet therapy increases the risk of bleeding but reduces the risk of major adverse cardiac events. This systematic review will discuss the effectiveness of long-term dual antiplatelet therapy as a secondary deterrent to major adverse cardiac events presented in the meta-analysis.

Results: Four RCTs with 8.797 patients were included in this study. A total of 4.414 patients received multiple antiplatelet therapies for ≥ 12 months. Patients involved in this study were aged 60 to 67 years. The patient was diagnosed with STEMI (n = 896), NSTEMI (1.206), unstable angina pectoris (3.288), and stable angina pectoris (n = 2.869). Regarding survival endpoints, there was no significant difference in all-cause mortality. The analysis showed that the OR of myocardial infarction was 0.96 [0.66, 1.37], the OR of thrombosis was 0.75 [0.32, 1.75], and the OR of stroke was 1.04 [0.57, 1.88]. Regarding bleeding endpoints, there was a significant difference between the two groups, the OR of bleeding was 1.18 [0.66, 2.11]. Multiple antiplatelets taken for ≥ 12 months may reduce the risk of developing myocardial infarction and thrombosis compared with short antiplatelet agents. The incidence of stroke and bleeding in both treatment groups receiving long-term dual antiplatelet therapy increased.

Conclusion: Long-term antiplatelet therapy can reduce the risk of major adverse cardiac events and be a secondary deterrent. However, long-term consumption of antiplatelets can increase the risk of bleeding, and the bleeding events are not fatal.

 

Latar Belakang: Penggunaan antiplatelet jangka panjang dilaporkan dapat meningkatkan risiko terjadinya perdarahan namun menurunkan risiko major adverse cardiac event. Dalam tinjauan sistematis ini akan dibahas lebih jauh mengenai efektivitas terapi antiplatelet ganda jangka panjang sebagai pencegah sekunder major adverse cardiac event yang disajikan dalam meta analisis.

Hasil: Dalam tinjauan ini terdapat 4 studi yang relevan dengan seluruh studi merupakan studi blinded. Terdapat total 8,797 pasien acute coronary syndrome dengan persentase laki-laki sebesar 76%. Total 4,414 pasien yang mendapatkan terapi antiplatelet ganda ≥ 12 bulan. Dalam tinjauan ini digunakan kelompok yang mendapatkan terapi antiplatelet ≤ 6 bulan sebagai pembanding. Partisipan yang terlibat dalam studi ini berusia 60 sampai 67 tahun. Pasien terdiagnosa dengan STEMI  (n=896), NSTEMI (1,206), angina pektoris tidak stabil (3,288), dan angina pektoris stabil (n=2,869).  Hasil analisis didapatkan OR kejadian infark miokard 0,96 [0,66, 1,37], OR kejadian trombosis 0,75 [0,32, 1,75], OR kejadian stroke 1,04 [0,57, 1,88] dan OR kejadian perdarahan 1,18 [0,66, 2,11]. Antiplatelet ganda yang dikonsumsi dalam waktu ≥ 12 bulan dapat menurunkan risiko terjadinya infark miokard dan trombosis dibandingkan dengan antiplatelet jangka pendek. Kejadian stroke dan perdarahan pada kedua kelompok perlakukan yang mendapatkan terapi antiplatelet ganda jangka panjang meningkat.

Kesimpulan: Terapi antiplatelet jangka panjang dapat menurunkan risiko terjadinya major adverse cardiac event dan dapat dijadikan sebagai pencegah sekunder. Namun, konsumsi antiplatelet jangka panjang dapat meningkatkan risiko terjadinya perdarahan. Meskipun demikian, kejadian perdarahan tidak bersifat fatal.

References

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How to Cite

Sanjiwani, N. P. G. R., IGN Putra Gunadhi, & Aryadana, W. (2021). Terapi jangka panjang antiplatelet ganda (≥ 12 bulan) pada acute coronary syndrome sebagai pencegah sekunder terhadap major adverse cardiac event : a systematic review and meta-analysis of randomized controlled trials. Intisari Sains Medis, 12(3), 1064–1073. https://doi.org/10.15562/ism.v12i3.932

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Ni Putu Gita Raditya Sanjiwani
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IGN Putra Gunadhi
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Wayan Aryadana
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