Indobufen-based dual antiplatelet therapy in patients undergoing PCI: a systematic review and meta-analysis

Background Conventional dual antiplatelet therapy (DAPT) post percutaneous coronary intervention (PCI) comprises aspirin and a P2Y 12 inhibitor. However, aspirin increases gastrointestinal and bleeding risks. Indobufen, a reversible COX-1 inhibitor, may offer a safer alternative. Objectives To evaluate whether replacing aspirin with indobufen in DAPT provides comparable efficacy and improved safety in patients undergoing PCI. Methods Six databases were systematically searched until 24 February 2026. The primary outcomes were major adverse cardiovascular events (MACE) for efficacy and bleeding events for safety. Subgroup analyses, particularly for acute coronary syndrome (ACS) patients, were conducted. Results Twelve studies involving 7,928 patients were included. Indobufen demonstrated comparable efficacy to aspirin in preventing MACE (OR = 0.89, 95% CI 0.73–1.10, P = 0.284). Crucially, indobufen significantly reduced bleeding events compared to aspirin (OR = 0.51, 95% CI 0.35–0.74, P < 0.001). Subgroup analyses across ACS status and specific P2Y 12 inhibitors (clopidogrel or ticagrelor) consistently supported these findings. Conclusion For patients undergoing PCI, an indobufen-based DAPT regimen appears to reduce bleeding risk while offering comparable MACE prevention relative to conventional aspirin-based DAPT. However, these findings should be interpreted cautiously due to existing limitations.