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- Title
Short versus long duration of dual antiplatelet therapy following drug-eluting stents: a meta-analysis of randomised trials.
- Authors
Rozemeijer, R.; Voskuil, M.; Greving, J. P.; Bots, M. L.; Doevendans, P. A.; Stella, P. R.
- Abstract
Background: Dual antiplatelet therapy (DAPT) remains the cornerstone therapy in the prevention of ischaemic events following drug-eluting stent (DES) implantation. Mandatory duration of DAPT after DES however, is a matter of debate. We aimed to evaluate safety and efficacy of short-term (up to 6 months) versus long-term (12 months) DAPT after DES implantation.Methods: We searched PubMed, EMBASE, Cochrane databases, and international meetings for randomised clinical trials (RCTs) comparing short with long DAPT. We performed a systematic review and meta-analysis of major trials with primary outcomes: all-cause death, myocardial infarction, definite or probable stent thrombosis, stroke, and major bleeding event.Results: Nine RCTs with a total number of 19,099 patients were pooled in the present meta-analysis. When compared with long DAPT, short DAPT was associated with a significant reduction in major bleeding events (0.62% vs. 1.10%, risk ratio (RR) 0.58, 95% confidence interval (CI) 0.39 to 0.86, <italic>p</italic> < 0.007, I2 = 21%), whereas all-cause death (1.65% vs. 1.84%, RR 0.90, 95% CI 0.73 to 1.11, <italic>p</italic> = 0.34, I2 = 0%), myocardial infarction (1.91% vs. 1.68%, RR 1.14, 95% CI 0.92 to 1.40, <italic>p</italic> = 0.23, I2 = 0%), definite or probable stent thrombosis (0.62% vs. 0.47%, RR 1.25, 95% CI 0.84 to 1.86, <italic>p</italic> = 0.27, I2 = 0%), and stroke (0.60% vs. 0.67%, RR 0.91, 95% CI 0.63 to 1.31, <italic>p</italic> = 0.61, I2 = 0%) were similar.Conclusions: Short DAPT following DES implantation results in a significant reduction of major bleeding events with no apparent increase in all-cause death, myocardial infarction, stent thrombosis, or stroke. Future dedicated trials should investigate the optimal strategies for patient-tailored DAPT in various subgroups.
- Subjects
PLATELET aggregation inhibitors; DRUG-eluting stents; RANDOMIZED controlled trials; ISCHEMIA prevention; COMPLICATIONS of cardiac surgery; THERAPEUTICS
- Publication
Netherlands Heart Journal, 2018, Vol 26, Issue 5, p242
- ISSN
1568-5888
- Publication type
Article
- DOI
10.1007/s12471-018-1104-6