Jungwook Heo

Yuhan University, South Korea

Title: Comparative Safety and Efficacy of Indobufen-Based Dual Antiplatelet Therapy Versus Contemporary Antiplatelet Strategies After Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis

---

Biography

Ungwook Matthias Heo is a biopharmaceutical science researcher and Principal Investigator based in South Korea, with a multidisciplinary focus on cardiovascular research, clinical meta-analysis, microbiome science, and oncology. He serves as Lead Researcher and Principal Investigator at NSRI Group 26, where he leads a PROSPERO-registered multinational systematic review examining the relationships between gut microbiota dysbiosis, intestinal permeability, and systemic inflammation in chronic heart failure (CRD420261335599).

His scholarly work has been selected for presentation at the 2026 ASCO Annual Meeting in Chicago and has been featured in the Journal of Clinical Oncology as a co-first author, with the corresponding manuscript currently under peer review at the Asia-Pacific Journal of Clinical Oncology (Wiley). He has also contributed to several international research collaborations in cardiology and oncology, with additional manuscripts currently under peer review in peer-reviewed international journals.

Heo serves as an Ambassador for IMGsAcademy and is actively engaged with K-BioX, one of South Korea’s largest life science research networks. His research interests center on integrating clinical evidence synthesis, microbiome science, and translational medicine to advance cardiovascular and human health outcomes.

Abstract

Introduction: Indobufen, a reversible cyclooxygenase-1 inhibitor, has been proposed as an alternative to aspirin within dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). Existing pairwise meta-analyses have only positioned indobufen against aspirin-based DAPT, leaving its place within the contemporary aspirin-free and DAPT de-escalation landscape unresolved. This study aims to estimate the relative safety and efficacy of indobufen-based DAPT compared with aspirin-based DAPT in patients undergoing PCI.

Methods: We searched PubMed, Embase, and CENTRAL from inception to February 2026 for randomized controlled trials and prospective cohort studies of antiplatelet strategies after PCI reporting Bleeding Academic Research Consortium (BARC) type 2–5 bleeding, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction, definite or probable stent thrombosis, target lesion revascularization, or net adverse clinical events (NACE). Risk of bias was assessed with RoB 2.0 and ROBINS-I. A Bayesian random-effects network meta-analysis was performed in R (gemtc), with treatments ranked by the surface under the cumulative ranking curve (SUCRA).

Results: Twenty-eight studies (24 RCTs, 4 cohort studies) enrolling 105,742 participants and contributing to a connected network of eight antiplatelet strategies were included. Compared with aspirin + clopidogrel (reference), ticagrelor monotherapy after short DAPT was associated with the lowest risk of BARC 2–5 bleeding (OR 0.56, 95% credible interval [CrI] 0.46–0.68) without any increase in MACCE (OR 0.99, 95% CrI 0.83–1.18). Indobufen + clopidogrel showed a small bleeding signal (OR 1.03, 95% CrI 0.99–1.08) and comparable MACCE (OR 1.02, 95% CrI 0.84–1.25). Cilostazol-based triple therapy did not reduce bleeding (OR 1.12, 95% CrI 0.86–1.46) but was associated with lower target lesion revascularization (OR 0.61, 95% CrI 0.45–0.83). Clopidogrel monotherapy after short DAPT reduced bleeding (OR 0.66, 95% CrI 0.49–0.88) without compromising MACCE in chronic coronary syndromes, but not in acute coronary syndromes. SUCRA rankings identified ticagrelor monotherapy as most likely to be the safest strategy and cilostazol-based triple therapy as most likely to be the most effective for restenosis prevention; indobufen-based DAPT ranked intermediate for both outcomes.

Conclusions: Within a connected evidence network, indobufen-based DAPT is non-inferior to aspirin-based DAPT for ischemic protection but offers no clear bleeding advantage over modern aspirin-free regimens. Ticagrelor monotherapy after short DAPT consistently provides the most favourable balance between bleeding and ischemic outcomes. These findings reposition indobufen as a niche option for patients with documented aspirin intolerance.