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- Title
Very Short Versus Longer Dual Antiplatelet Treatment After Coronary Interventions: A Systematic Review and Meta-analysis.
- Authors
Tsigkas, Grigorios; Apostolos, Anastasios; Trigka, Aikaterini; Chlorogiannis, Dimitrios; Katsanos, Konstantinos; Toutouzas, Konstantinos; Alexopoulos, Dimitrios; Brilakis, Emmanouil S.; Davlouros, Periklis
- Abstract
Background: Very short (≤ 3 months) duration of dual antiplatelet therapy (VSDAPT) has recently been proposed after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Objectives: The aim of this systematic review and meta-analysis was to compare very short versus > 3 months' duration of dual antiplatelet treatment (DAPT) in patients undergoing PCI with DES, focusing on ischemic and bleeding events. Methods: Three major databases (Medline, Cochrane Central Register of Controlled Trials, and Scopus) were screened for eligible randomized controlled trials (RCTs). The primary endpoint of our meta-analysis was the incidence of net adverse clinical events (NACE), as defined per trial, while secondary endpoints were major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, repeat revascularization, and major bleeding. Results: We included eight RCTs with a total of 41,204 patients; 20,592 patients were allocated to VSDAPT and the remaining 20,612 patients were randomized to a longer DAPT period. The abbreviated regimen significantly reduced NACE (odds ratio [OR] 0.83, 95% confidence interval [Cl] 0.74–0.95) and major bleeding (OR 0.71, 95% Cl 0.61–0.82), without affecting mortality or ischemic events (stroke, myocardial infarction, revascularization, and stent thrombosis). Conclusions: VSDAPT significantly decreased the odds of NACEs and major bleeding by 17% and 29%, respectively, without increasing ischemic events. Thus, VSDAPT could be well tolerated and feasible after PCI with DES. Clinical Trials Registration: Open Science Framework (10.17605/OSF.IO/4H2JB) Very short-term DAPT significantly reduces NACE and major bleedings, without affecting mortality and ischemic events (MACE, MI, stroke, stent thrombosis and revascularization). CI confidence intervals, DAPT dual antiplatelet therapy, DES drug-eluting stents, MACE major adverse cardiovascular events, MI myocardial infarction, NACE net adverse clinical events, OR odds ratio, PCI percutaneous coronary interventions.
- Subjects
CARDIOVASCULAR disease related mortality; DRUG efficacy; MEDICAL databases; CAUSES of death; THROMBOSIS; ENOXAPARIN; COMBINATION drug therapy; PERCUTANEOUS coronary intervention; META-analysis; STROKE; CONFIDENCE intervals; DRUG-eluting stents; SYSTEMATIC reviews; MAJOR adverse cardiovascular events; TREATMENT duration; DISEASE incidence; MYOCARDIAL infarction; REGRESSION analysis; PLATELET aggregation inhibitors; RESEARCH funding; MYOCARDIAL revascularization; REOPERATION; LOW-molecular-weight heparin; DISEASE prevalence; MEDLINE; DRUG side effects; ODDS ratio; DATA analysis software; STATISTICAL models; HEMORRHAGE; DISEASE risk factors
- Publication
American Journal of Cardiovascular Drugs, 2023, Vol 23, Issue 1, p35
- ISSN
1175-3277
- Publication type
Article
- DOI
10.1007/s40256-022-00559-0