Key result
Short DAPT cuts major bleeding ~36% vs standard therapy in HBR patients with new-generation DES.
Why the study?
It had not been ascertained whether shortening the duration of dual antiplatelet therapy benefits high bleeding risk patients after PCI.
Does short DAPT (≤ 3 months) reduce major bleeding without increasing ischemic events in high bleeding risk patients after PCI with new-generation DES?
Meta-Analysis (n=15,432)
Does short DAPT (≤ 3 months) reduce major bleeding without increasing ischemic events in high bleeding risk patients after PCI with new-generation DES?
Effect estimate: RR 0.64 (95% CI 0.44, 0.95)
Absolute Event Rate: 2.3% vs 3.2%
p-value: p=0.03
In high bleeding risk patients undergoing PCI with new-generation DES, short DAPT (≤3 months) reduces major bleeding without increasing the risk of stent thrombosis or myocardial infarction compared to standard DAPT.
Short DAPT (≤3 months) may be preferred in high-bleeding-risk patients after new-generation DES PCI to cut major bleeding; confirms ischemic safety.
BACKGROUND: To date, it has not been ascertained whether shortening the duration of dual antiplatelet therapy (DAPT) can benefit high bleeding risk (HBR) patients. This systematic review and meta-analysis was performed to investigate the safety and efficacy of short (≤ 3 months) DAPT in HBR patients after percutaneous coronary intervention (PCI). METHODS: The PubMed, Embase, and Clinical Trials databases were searched from inception until November 2021 to identify studies that evaluated the safety and efficacy of short DAPT in HBR patients implanted with new-generation drug-eluting stents (DES). Primary endpoints included major bleeding, definite or probable stent thrombosis (ST), and myocardial infarction (MI), while secondary endpoints included all-cause death and ischemic stroke. Based on the fixed and random effect model, the risk ratio (RR) and 95% confidence interval of each endpoint were measured. RESULTS: Five observational studies and one randomized controlled trial were included, involving 15,432 HBR patients. Short DAPT for HBR patients undergoing PCI had a lower incidence of major bleeding in comparison with standard (> 3 months) DAPT (2.3% vs. 3.2%, RR 0.64 [0.44, 0.95], p = 0.03), while short DAPT was comparable to standard DAPT with regard to definite or probable ST (0.4% vs. 0.3%, RR 1.31 [0.77, 2.23], p = 0.32) and MI (2.4% vs. 2.0%, RR 1.17 [0.95, 1.45], p = 0.14). CONCLUSIONS: Among HBR patients implanted with new-generation DES, short DAPT was associated with reduced risk of major bleeding without significantly increasing the risk of definite or probable ST and MI in comparison with standard DAPT.
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Han et al. (2022) conducted a meta-analysis in High bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (n=15,432). Short dual antiplatelet therapy (DAPT) vs. Standard DAPT (> 3 months) was evaluated on Major bleeding (BARC 3 or 5) (RR 0.64, 95% CI 0.44, 0.95, p=0.03). Among high bleeding risk patients implanted with new-generation drug-eluting stents, short dual antiplatelet therapy (≤3 months) reduced the risk of major bleeding by 36% (RR 0.64) compared to standard therapy.
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