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Umbrella review and meta‐analysis of antiplatelet therapy for peripheral artery disease

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Umbrella review and meta‐analysis of antiplatelet therapy for peripheral artery disease. / Ambler, G. K.; Waldron, C.-A.; Contractor, U. B.; Hinchliffe, R. J.; Twine, C. P.

In: British Journal of Surgery, Vol. 107, No. 1, 01.01.2020, p. 20-32.

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Ambler, G. K. ; Waldron, C.-A. ; Contractor, U. B. ; Hinchliffe, R. J. ; Twine, C. P. / Umbrella review and meta‐analysis of antiplatelet therapy for peripheral artery disease. In: British Journal of Surgery. 2020 ; Vol. 107, No. 1. pp. 20-32.

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@article{0c40e346190c4966908b3eb3d6d4da15,
title = "Umbrella review and meta‐analysis of antiplatelet therapy for peripheral artery disease",
abstract = "Objective: The literature on antiplatelet therapy for peripheral arterial disease has historically been summarised inconsistently, leading to conflict between international guidleines. An umbrella review and meta-analysis was performed to clearly summarise the literature, allow assessment of competing safety risks and clinical benefits, and identify weak areas for future research. Methods: MEDLINE, EMBASE, DARE, PROSPERO and Cochrane databases were searched from inception until January 2019. All meta-analyses of antiplatelet therapy in peripheral arterial disease were included. Quality was assessed using Amstar scores, with GRADE analysis quantifying strength of evidence. Data were pooled using random-effects models.Results: Twenty-eight meta-analyses were included. Thirty-three clinical outcomes and 41 antiplatelet comparisons in 72,181 patients were analysed. High-quality evidence showed antiplatelet monotherapy reduced non-fatal strokes and cardiovascular death in symptomatic patients (3 and 8 fewer per 1000 patients respectively, 95{\%} CI 0–6 and 0–16), but increased risk of major bleeding (7 more per 1000, 95{\%} CI 3–14). In asymptomatic patients, monotherapy reduced non-fatal strokes (5 fewer per 1000, 95{\%} CI 0–8) but had no other clinical benefit. Dual antiplatelet therapy caused more major bleeding after intervention than monotherapy (37 more per 1000, 95{\%} CI 8–102), with very low-quality evidence of improved endovascular patency (Relative Risk 4.00, 95{\%} CI 0.91–17.68).Conclusions: Antiplatelet monotherapy has minimal clinical benefit for asymptomatic peripheral arterial disease, and limited benefit for symptomatic disease, with clear risk of major bleeding. There is a lack of evidence to guide antiplatelet prescribing after peripheral endovascular intervention which needs addressing by adequately powered randomised trials.Study registration: PROSPERO 2017 CRD42017084223",
keywords = "antiplatelet therapy, peripheral arterial disease, systematic review, meta-analysis",
author = "Ambler, {G. K.} and C.-A. Waldron and Contractor, {U. B.} and Hinchliffe, {R. J.} and Twine, {C. P.}",
year = "2020",
month = "1",
day = "1",
doi = "10.1002/bjs.11384",
language = "English",
volume = "107",
pages = "20--32",
journal = "British Journal of Surgery",
issn = "0007-1323",
publisher = "Wiley",
number = "1",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - Umbrella review and meta‐analysis of antiplatelet therapy for peripheral artery disease

AU - Ambler, G. K.

AU - Waldron, C.-A.

AU - Contractor, U. B.

AU - Hinchliffe, R. J.

AU - Twine, C. P.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objective: The literature on antiplatelet therapy for peripheral arterial disease has historically been summarised inconsistently, leading to conflict between international guidleines. An umbrella review and meta-analysis was performed to clearly summarise the literature, allow assessment of competing safety risks and clinical benefits, and identify weak areas for future research. Methods: MEDLINE, EMBASE, DARE, PROSPERO and Cochrane databases were searched from inception until January 2019. All meta-analyses of antiplatelet therapy in peripheral arterial disease were included. Quality was assessed using Amstar scores, with GRADE analysis quantifying strength of evidence. Data were pooled using random-effects models.Results: Twenty-eight meta-analyses were included. Thirty-three clinical outcomes and 41 antiplatelet comparisons in 72,181 patients were analysed. High-quality evidence showed antiplatelet monotherapy reduced non-fatal strokes and cardiovascular death in symptomatic patients (3 and 8 fewer per 1000 patients respectively, 95% CI 0–6 and 0–16), but increased risk of major bleeding (7 more per 1000, 95% CI 3–14). In asymptomatic patients, monotherapy reduced non-fatal strokes (5 fewer per 1000, 95% CI 0–8) but had no other clinical benefit. Dual antiplatelet therapy caused more major bleeding after intervention than monotherapy (37 more per 1000, 95% CI 8–102), with very low-quality evidence of improved endovascular patency (Relative Risk 4.00, 95% CI 0.91–17.68).Conclusions: Antiplatelet monotherapy has minimal clinical benefit for asymptomatic peripheral arterial disease, and limited benefit for symptomatic disease, with clear risk of major bleeding. There is a lack of evidence to guide antiplatelet prescribing after peripheral endovascular intervention which needs addressing by adequately powered randomised trials.Study registration: PROSPERO 2017 CRD42017084223

AB - Objective: The literature on antiplatelet therapy for peripheral arterial disease has historically been summarised inconsistently, leading to conflict between international guidleines. An umbrella review and meta-analysis was performed to clearly summarise the literature, allow assessment of competing safety risks and clinical benefits, and identify weak areas for future research. Methods: MEDLINE, EMBASE, DARE, PROSPERO and Cochrane databases were searched from inception until January 2019. All meta-analyses of antiplatelet therapy in peripheral arterial disease were included. Quality was assessed using Amstar scores, with GRADE analysis quantifying strength of evidence. Data were pooled using random-effects models.Results: Twenty-eight meta-analyses were included. Thirty-three clinical outcomes and 41 antiplatelet comparisons in 72,181 patients were analysed. High-quality evidence showed antiplatelet monotherapy reduced non-fatal strokes and cardiovascular death in symptomatic patients (3 and 8 fewer per 1000 patients respectively, 95% CI 0–6 and 0–16), but increased risk of major bleeding (7 more per 1000, 95% CI 3–14). In asymptomatic patients, monotherapy reduced non-fatal strokes (5 fewer per 1000, 95% CI 0–8) but had no other clinical benefit. Dual antiplatelet therapy caused more major bleeding after intervention than monotherapy (37 more per 1000, 95% CI 8–102), with very low-quality evidence of improved endovascular patency (Relative Risk 4.00, 95% CI 0.91–17.68).Conclusions: Antiplatelet monotherapy has minimal clinical benefit for asymptomatic peripheral arterial disease, and limited benefit for symptomatic disease, with clear risk of major bleeding. There is a lack of evidence to guide antiplatelet prescribing after peripheral endovascular intervention which needs addressing by adequately powered randomised trials.Study registration: PROSPERO 2017 CRD42017084223

KW - antiplatelet therapy

KW - peripheral arterial disease

KW - systematic review

KW - meta-analysis

U2 - 10.1002/bjs.11384

DO - 10.1002/bjs.11384

M3 - Article

C2 - 31808552

VL - 107

SP - 20

EP - 32

JO - British Journal of Surgery

JF - British Journal of Surgery

SN - 0007-1323

IS - 1

ER -