Sex differences in dual antiplatelet therapy de-escalation strategies after percutaneous coronary intervention: a network meta-analysis.

However, the potential impact of sex on the safety and efficacy of these strategies is yet to be fully investigated.

然而，性别对这些策略的安全性和有效性潜在影响尚未得到充分调查。

Methods

Randomized controlled trials comparing de-escalated vs standard DAPT regimens in patients without baseline indication for oral anticoagulation reporting outcomes stratified by sex were included.

纳入了比较降阶梯与标准双重抗血小板治疗方案的随机对照试验，这些试验针对没有口服抗凝治疗基线指征的患者，并报告了按性别分层的结果。

The co-primary endpoints were trial-defined major adverse cardiovascular events (MACE) and major bleeding.

共同主要终点是试验定义的主要不良心血管事件（MACE）和主要出血。

Hazard ratios (HR) with 95% confidence intervals (CI) were computed to account for different follow-up durations.

计算了包括95%置信区间在内的风险比（HR），以考虑不同的随访时长。

A network meta-analysisincluding ranking of treatments was performed to explore the comparative effects of different DAPT de-escalation strategies among females and males.

进行了包括治疗排名的网络荟萃分析，以探讨不同DAPT降阶策略在女性和男性中的比较效果。

Results

Overall, 71 272 patients from 20 trials were included, and 23.3% were female.

总体而言，20项试验共纳入了71,272名患者，其中23.3%为女性。

De-escalation strategies were grouped into (1) DAPT discontinuation, by aspirin or the P2Y12 inhibitor; or (2) P2Y12 inhibitor switch or dose reduction.

降阶梯策略被分为以下几类：(1) 停用DAPT，通过停用阿司匹林或P2Y12抑制剂；或(2) P2Y12抑制剂的转换或剂量减少。

With DAPT discontinuation vs standard DAPT, a significant interaction between treatment effect and sex was found for both MACE (Pint = .028) and major bleeding (Pint = .015).

与标准双联抗血小板治疗（DAPT）相比，停用DAPT与性别之间对主要不良心血管事件（MACE）和主要出血事件的治疗效果存在显著的相互作用（Pint分别为.028和.015）。

Indeed, DAPT discontinuation reduced MACE in females (HR, 0.86; 95% CI, 0.75-0.98) but not in males (HR, 1.04; 95% CI 0.93-1.16), while reducing major bleeding in males (HR, 0.60; 95% CI, 0.44-0.82) but not in females (HR, 1.04; 95% CI, 0.76-1.43), compared to standard DAPT.

实际上，与标准DAPT相比，停用DAPT在女性中减少了MACE（风险比[HR]，0.86；95%置信区间[CI]，0.75-0.98），但在男性中没有减少（HR，1.04；95% CI 0.93-1.16），同时在男性中减少了主要出血事件（HR，0.60；95% CI，0.44-0.82），但在女性中没有减少（HR，1.04；95% CI，0.76-1.43）。

Conversely, no interactions by sex were found with P2Y12 inhibitor switch or dose reduction vs standard DAPT for both MACE (Pint = .668) and major bleeding (Pint = .858).

相反地，性别与P2Y12抑制剂转换或减量相比标准DAPT在主要不良心血管事件（Pint = .668）和主要出血（Pint = .858）方面未发现交互作用。

At treatment ranking, aspirin discontinuation ranked best for most outcomes in females, while P2Y12 inhibitor switch to clopidogrel showed the best outcomes in males.

在治疗排名方面，女性中阿司匹林停药在大多数结果中排名最高，而男性中P2Y12抑制剂转换为氯吡格雷显示出最佳结果。

Conclusions

Sex may influence the safety and efficacy of antiplatelet de-escalation strategies after PCI, particularly those involving the shortening of DAPT.

性别可能会影响经皮冠状动脉介入治疗（PCI）后抗血小板药物降阶策略的安全性和有效性，尤其是那些涉及缩短双联抗血小板治疗（DAPT）时长的策略。

Aspirin discontinuation may represent the optimal strategy for females, while P2Y12 inhibitor switch to clopidogrel may be most effective for males.

对于女性患者，停用阿司匹林可能是最佳策略，而对于男性患者，将 P2Y12 抑制剂更换为氯吡格雷可能是最有效的。