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- Title
2015 - Review: After coronary DES placement, shorter vs longer dual-antiplatelet therapy reduces mortality.
- Authors
Bates, Eric R.
- Abstract
Question After coronary drug-eluting stent (DES) implantation, what are the efficacy and safety of different durations of dual-antiplatelet therapy (DAPT)? Review scope Included studies compared different durations (≤ 6 mo vs 1 y vs > 1 y) of DAPT after DES implantation. Primary outcome was all-cause mortality. Other outcomes were cardiac mortality, noncardiac mortality, myocardial infarction (MI), stroke, stent thrombosis (definite or probable), any bleeding, and major bleeding. Review methods MEDLINE, EMBASE/Excerpta Medica, Cochrane databases, www.clinicaltrials.gov and other Web sites (www.tctmd.com, www.clinicaltrialresults.org, www.cardiosource.com), and proceedings from major cardiovascular meetings were searched for randomized controlled trials (RCTs). 10 RCTs (n = 31 666, mean age 62 to 68 y, 63% to 81% men, follow-up 9 to 24 mo) published between Dec 2011 and Nov 2014 met the inclusion criteria and had sufficient data for analysis. 2 RCTs compared DAPT for 3 vs 12 months, 3 for 6 vs 12 months, 2 for 6 vs 24 months, and 3 for 12 vs 18 to 36 months. Type of stent used varied across studies. All 10 RCTs blinded outcome adjudicators and had adequate allocation concealment and follow-up data, 2 were described as double-blind, and 9 used intention-to-treat analysis. Main results Compared with longer DAPT, shorter DAPT reduced all-cause mortality, noncardiac mortality, and major or any bleeding; increased MI and stent thrombosis; and did not differ for cardiac mortality or stroke (Table). Conclusion After coronary drug-eluting stent placement, shorter-duration dual-antiplatelet therapy reduces all-cause mortality compared with longer-duration therapy.
- Subjects
COMBINATION drug therapy; CONFIDENCE intervals; CORONARY disease; HEMORRHAGE; INFORMATION storage &; retrieval systems; MEDICAL databases; MEDICAL information storage &; retrieval systems; LONGITUDINAL method; MEDLINE; META-analysis; MORTALITY; MYOCARDIAL infarction; MYOCARDIAL revascularization; STROKE; TRANSLUMINAL angioplasty; SYSTEMATIC reviews; RANDOMIZED controlled trials; RELATIVE medical risk; TREATMENT effectiveness; TREATMENT duration; PLATELET aggregation inhibitors; DRUG-eluting stents; DESCRIPTIVE statistics
- Publication
ACP Journal Club, 2015, Vol 163, Issue 2, p1
- ISSN
1056-8751
- Publication type
Article