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PurposeThis meta-analysis aimed to compare the safety and efficacy of aspirin and indobufen in patients with coronary heart disease. The primary focus was on the incidence of cardiovascular events, bleeding events, and gastrointestinal reactions. Given the relatively limited research on indobufen, this study utilized aspirin as a control drug and employed meta-analysis to integrate existing clinical studies. The goal was to provide a reference for the clinical use of indobufen and to suggest directions for further largescale, multicenter prospective studies.MethodsThis review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a comprehensive search of the PubMed, EMBASE, WOS, and Cochrane Library databases to identify all relevant literature on indobufen. A total of nine trials met the inclusion criteria, encompassing seven randomized controlled trails (RCTs) and two retrospective studies. Categorical variables were analyzed using odds ratio and random effects models.ResultsThe meta-analysis included nine trials, comprising seven RCTs and two retrospective studies. The pooled results indicated that indobufen significantly reduced the incidence of minor bleeding events, and gastrointestinal discomfort compared to aspirin. However, both drugs had similar effects on the incidence of recurrent angina pectoris, myocardial infarction and mortality due to coronary heart disease.ConclusionIndobufen was associated with fewer gastrointestinal reactions and a low risk of bleeding, making it a viable option for patients with high-risk factors for bleeding and gastric ulcers. Despite this, indobufen's short history and limited evidence base compared to aspirin highlight the need for further research. Aspirin remains widely available, cost-effective, and the preferred drug for the primary and secondary prevention of cardiovascular and cerebrovascular diseases. Indobufen or other antiplatelet agents should only be considered when aspirin is not tolerated or contraindicated. Further clinical trials are necessary to determine whether indobufen can replace aspirin.Systematic review registrationhttps://www.crd.york.ac.uk/, identifier [CRD42024523477].

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ObjectiveThe optimal low-dose antiplatelet agents in patients with coronary heart disease (CHD) had not been determined. The objective of this study was to compare the impact of different low-dose antiplatelet agents on cardiovascular outcomes and bleeding risks in patients with CHD.MethodsWe searched PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, VIP, WanFang Data, and China Biology Medicine. Randomized controlled trials (RCTs) enrolling patients with CHD treated with different low-dose platelet aggregation inhibitors were included. The revised Cochrane Risk of Bias Tool for Randomized Trials Risk was used to assess risk of bias in RCTs. A Bayesian random network meta-analysis (NMA) was conducted, with odds ratios (OR) and 95% confidence intervals (CI) as effect estimates in R 4.2.2 software and Stata 15.0. The quality of evidence was assessed using the Confidence in NMA framework.ResultsSixteen RCTs involving 6350 patients were included. All participants were treated with a recommended dose of aspirin plus a low or standard dose of P2Y12 receptor antagonist. Low-level evidence indicated the risk of major adverse cardiovascular events (MACE) was similar among low doses of prasugrel, ticagrelor, standard doses of prasugrel, ticagrelor, and clopidogrel. Low- to moderate-level evidence suggested there was no difference in bleeding risk among low dose of prasugrel, ticagrelor, clopidogrel compared to standard dose of prasugrel, ticagrelor, and clopidogrel. NMA showed that low dose of prasugrel had the highest probability of being the best intervention in terms of MACE, myocardial infarction, and bleeding events leading to discontinuation.ConclusionBased on low-level evidence, low dose of prasugrel combined with standard dose of aspirin can be recommended for patients with CHD, low dose of ticagrelor was similar in terms of MACE and bleeding compared with standard dose of P2Y12 receptor antagonist. The systematic review was registered in PROSPERO with the registration number CRD42023438376.

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Background and purposeThe objective of this study is to systematically review the efficacy and safety of cilostazol-based dual antiplatelet therapy (DAPT) in patients with stroke.MethodsTwo reviewers conducted a comprehensive search of eligible studies published in PubMed, Medline, the Cochrane Library, Embase, and four Chinese databases from their establishment to 31 July 2024. The review was registered (CRD42024559047).ResultsThis study included a total of 4,473 subjects from 11 studies. The results indicated that, when compared to aspirin/clopidogrel single antiplatelet therapy (SAPT), cilostazol-based DAPT was associated with lower ischemic stroke (RR = 0.54, 95% CI 0.38-0.75, P = 0.0003) and any stroke recurrence (RR = 0.52, 95% CI 0.31-0.86, P = 0.01). Furthermore, the incidence of general adverse events was higher in the cilostazol-based DAPT (RR = 1.93, 95% CI 1.16-3.21, P = 0.01), while no statistically significant difference was observed between the two groups with regard to serious adverse events. The subgroup analysis of follow-up time revealed that the cilostazol-based DAPT regimen demonstrated superior efficacy in reducing the incidence of ischemic stroke recurrence (RR = 0.51; 95% CI 0.36-0.73; P = 0.0002) and any stroke recurrence (RR = 0.49; 95% CI 0.35-0.67; P 3 months) versus the short-term (≤3 months) group. Furthermore, the cilostazol-based DAPT regimen did not increase the risk of serious adverse events.ConclusionDAPT combined with cilostazol and aspirin or clopidogrel was superior to aspirin or clopidogrel alone, did not increase serious adverse events, and was more effective for long-term (>3 months) prophylaxis.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024559047.

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BackgroundThe pathogenesis of atherosclerotic thrombosis primarily involves platelet activation and aggregation, making antiplatelet therapy the cornerstone of treatment for such diseases.ObjectiveThis meta-analysis aimed to compare the safety and efficacy of aspirin and indobufen in antiplatelet therapy for patients with atherosclerotic diseases.MethodsWe searched the Cochrane Library, PubMed, Embase, Web of Science, and the Chinese Wanfang databases. The literature was screened according to predefined inclusion and exclusion criteria. Risk ratio (RR) was used to assess the magnitude of risk associated with exposure and our inclusion criteria are as follows: (1) the study population comprised adults (aged 18 years and older) with coronary heart disease caused by coronary artery atherosclerosis or stroke caused by intracranial atherosclerosis; (2) the intervention was represented by indobufen in the study groups versus aspirin in the control groups; (3) the primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events or any bleeding or Bleeding Academic Research Consortium 2/3/5 bleeding; (4) the secondary outcomes were cardiovascular death, myocardial infarction, and ischemic stroke; adverse cardiovascular events such as coronary thrombus reformation, heart failure, myocardial infarction, stroke, angina pectoris, and cardiovascular death; stroke; myocardial infarction; and cardiovascular death; and (5) the studies were randomized clinical trials with either crossover or parallel designs or prospective observational trials.ResultsEighteen trials with a total of 12,981 patients were included in this study. Compared to aspirin, indobufen reduced the risk of (1) bleeding events (RR 0.54, 95% CI 0.41-0.71; PConclusionsCompared with aspirin, indobufen demonstrated better safety and was not inferior to aspirin in terms of efficacy, with superior results in some aspects (eg, fewer risks of adverse cardiovascular events and myocardial infarction). Further studies with larger sample sizes or longer follow-up periods may provide additional evidence.

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