Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients
Why the study?
Does short-term dual antiplatelet therapy (≤6 months) improve outcomes or reduce bleeding compared to 1-year therapy in patients with or without acute coronary syndromes after DES implantation?
Population
11,473 patients from 6 randomized trials who underwent drug-eluting stent implantation, including 6,714 with…
Comparison
Short-term dual antiplatelet therapy consisting… vs Long-term dual antiplatelet therapy consisting…
Design
Meta-analysis
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
Supports 1-year DAPT in ACS to limit ischemic risk; extends evidence for presentation-specific duration post-DES.
Structured PICO
Does short-term dual antiplatelet therapy (≤6 months) improve outcomes or reduce bleeding compared to 1-year therapy in patients with or without acute coronary syndromes after DES implantation?
P
Population
11,473 patients from 6 randomized trials who underwent drug-eluting stent (DES) implantation, including 6,714 (58.5%) with stable CAD and 4,758 (41.5%) with acute coronary syndrome (ACS), the majority of whom (67.0%) had unstable angina.
I
Intervention
Short-term dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel for ≤6 months (specifically 3-month or 6-month durations).
C
Comparator
Long-term dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel for 1 year.
O
Outcome
1-year composite risk of myocardial infarction (MI) or definite/probable stent thrombosis (ST).composite
A 3-month DAPT strategy after DES implantation appears safe in stable CAD but is associated with increased ischemic risk in ACS patients, while prolonged DAPT consistently increases bleeding risk across both groups.
Limitations
- Most enrolled ACS patients were relatively low risk
Cite This Study
Palmerini et al. (2016) studied this question.