Antiagregación plaquetaria dual en prevención secundaria en enfermedad coronaria y cerebrovascular y trombocitopenia: Revisión Sistemática

Introduction: Coronary heart disease and cerebrovascular disease are the main causes of mortality and disability. Association with thrombocytopenia increases the risk of complications. Single and dual antiplatelet therapy are part of secondary prevention. However, antiplatelet therapy in patients with thrombocytopenia raises the risk of bleeding. Objective: The objective of this systematic review is to synthesize information on the potential risks and benefits of dual antiplatelet therapy compared to single or no antiplatelet therapy, in adults with thrombocytopenia in secondary prevention of coronary heart disease and cerebrovascular disease. Methods: A systematic literature review of randomized and non-randomized studies reporting efficacy and safety outcomes was performed in the main databases. Evidence quality was evaluated with the ROBINS I tool, and outcomes were reported through evidence profile tables. Results: Given the heterogeneity between studies, a meta-analysis of the data was not possible. Two studies indicated a lower rate of mortality and ischemic events with clopidogrel-based dual antiplatelet therapy, while one study found higher mortality with ticagrelor-based therapy. Major bleeding events were more frequent with ticagrelor-based therapy, while they were lower with clopidogrel-ASA. Conclusions: Evidence suggests a possible benefit of dual antiplatelet therapy in patients with thrombocytopenia in secondary prevention of coronary heart disease and cerebrovascular disease, especially with clopidogrel-ASA. The absence of randomized clinical trials and the limited information from non-randomized studies limits the possibility of making solid recommendations. The decision to use dual antiplatelet therapy should be guided by clinical judgment, considering individualized risks and benefits.