Lancet: Can P2Y12 inhibitors challenge the status of aspirin atherosclerosis secondary prevention?

Over the past few decades, the treatment of patients with atherosclerosismanagementhas made substantial progress, mainly through effective drug treatments, such as anti-
thrombosisstrategiesSecondarypreventionof antiplatelet drugs are currently recommended for diagnosed patientswith vascular, coronary artery or peripheral arterial diseaseAspirin is a drug chosen in clinical practice because it has been shown to have a net benefit in secondary prevention ofcardiovasculardiseaseIn addition, other antiplatelet drugs showed at least similar benefits to aspirin in patients with atherosclerosisP2Y12 inhibitors are the most commonly used antiplatelet drugs and can be used as an alternative to aspirinSeveral pharmacodynamic studies have shown that P2Y12 inhibitors inhibit platelets more powerfully than aspirin Many trials compared the secondary preventive effects of P2Y12 inhibitors and aspirin on axiosyatriosclerosis patients, with varying results In order to fully assess the comprehensive efficacy and quality of evidence, Mauro Chiarito, from Italy, etc., published their systematic review and meta analysis results in Lancet in May 2020, directly comparing the efficacy of P2Y12 inhibitor single drug therapy and aspirin monodrug therapy for secondary prevention in patients with atherosclerosis in this systematic review and meta-analysis, all randomized trials comparing the second-level preventive effects of P2Y12 inhibitors and aspirin monodrug therapy on patients with cerebrovascular, coronary artery or peripheral arterial disease were evaluated The main endpoint of the compound is myocardial infarction and stroke The critical secondary endpoint is total death and vascular death The study was registered as PROSPERO (CRD42018115037) a total of 9 randomized trials were included in the study in the , and 42,108 patients were randomly assigned to P2Y12 inhibitors (n?21043) or aspirin (n-21065) Patients treated with P2Y12 inhibitors were able to reduce the risk of myocardial infarction (critical) compared to those treated with aspirin (OR 0.81 (95% CI 0.66-0.99); Patients who received P2Y12 inhibitors had a risk of stroke (OR 0.93 (0.82-1.06); I2 s 34.5%), total death (OR 0.98 (0.89-1.08), I2-0% and vascular death (0.97 (0.86-1.09) and I2 s.0%) Similarly, there was no difference between patients receiving P2Y12 inhibitors who had a high erythema risk (OR 0.90 (0.74-1.10); I2-3.9%) compared to those receiving aspirin The NTT for the prevention of one case of myocardial infarction with P2Y12 inhibitors alone was 244 Regardless of the type of P2Y12 inhibitor used, the results are consistent the lead authors believe that in secondary prevention, P2Y12 inhibitor single-drug therapy reduces the risk of myocardial infarction compared to aspirin alone therapy, and the risk of stroke is similar The benefits of P2Y12 inhibitor single drug therapy are controversial because the nNT to prevent one case of myocardial infarction is too high and has no effect on the whole cause and vascular mortality