Key result
Compared with longer-term DAPT (>12 months), 6-month DAPT significantly lowered the risk of major bleeding (OR 0.50; 95% CI 0.29-0.83) after drug-eluting stent implantation.
Why the study?
The study aimed to evaluate the efficacy and safety of different dual antiplatelet therapy durations and regimens after PCI with drug-eluting stents.
Do shorter durations of dual antiplatelet therapy (1-6 months) reduce bleeding without increasing ischemic events compared to 12-month or longer DAPT in patients undergoing PCI with DES?
Meta-Analysis (n=81,339)
Do shorter durations of dual antiplatelet therapy (1-6 months) reduce bleeding without increasing ischemic events compared to 12-month or longer DAPT in patients undergoing PCI with DES?
Effect estimate: OR 0.50 (95% CI 0.29-0.83)
Short-term DAPT (1-3 months), particularly 3-month DAPT followed by P2Y12 monotherapy, reduces bleeding and net adverse clinical events without increasing mortality compared to longer DAPT, though longer DAPT reduces MI and stent thrombosis.
INTRODUCTION: This network meta-analysis aimed to evaluate the efficacy and safety of different dual antiplatelet therapies (DAPTs) after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). METHODS: Randomized controlled trials (RCTs) comparing longer-term (>12 months) DAPT (L-DAPT), 12-month DAPT (DAPT 12Mo), 6-month DAPT (DAPT 6Mo), 3-month DAPT followed by aspirin monotherapy (DAPT 3Mo + ASA), 3-month DAPT followed by a P2Y12 receptor inhibitor monotherapy (DAPT 3Mo + P2Y12), or 1-month DAPT with a P2Y12 receptor inhibitor monotherapy (DAPT 1Mo + P2Y12) were searched. Primary endpoints were all-cause mortality, cardiac death, myocardial infarction (MI), major bleeding, any bleeding, definite or probable stent thrombosis (ST), and net adverse clinical events (NACE). This Bayesian network meta-analysis was performed with the random-effects model. RESULTS: = 81339) were included. In comparison with L-DAPT, DAPT 6Mo (OR: 0.50, 95% CI: 0.29-0.83), DAPT 3Mo + P2Y12 (OR: 0.38, 95% CI: 0.18-0.82), DAPT 3Mo + ASA (OR: 0.44, 95% CI: 0.17-0.98), and DAPT 1Mo + P2Y12 (OR: 0.45, 95% CI: 0.14-0.93) were associated with a lower risk of major bleeding. DAPT 3Mo + P2Y12 (OR: 0.58, 95% CI: 0.38-0.88) reduced the risk of any bleeding when compared with DAPT 12Mo. L-DAPT decreased the risk of MI and definite or probable stent ST when compared with DAPT 6Mo. DAPT 3Mo + P2Y12 decreased the risk of NACE in comparison with DAPT 6Mo and DAPT 12Mo. No significant difference in all-cause mortality and cardiac death was observed. In patients with acute coronary syndrome, DAPT 6Mo was comparable to DAPT 12Mo. CONCLUSION: Short-term (1-3 months) DAPT is noninferior to DAPT 6Mo after DESs implantation, while L-DAPT reduces MI and definite or probable ST rates. DAPT 3Mo + P2Y12 might be a reasonable trade-off in patients with high risk of bleeding accompanied by ischemia.
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Xu et al. (2021) conducted a meta-analysis in Patients undergoing percutaneous coronary intervention with drug-eluting stents (n=81,339). Short-term DAPT (1-6 months) or DAPT followed by P2Y12/ASA monotherapy vs. Longer-term DAPT (>12 months) or 12-month DAPT was evaluated on Major bleeding (DAPT 6Mo vs L-DAPT) (OR 0.50, 95% CI 0.29-0.83). Compared with longer-term DAPT (>12 months), 6-month DAPT significantly lowered the risk of major bleeding (OR 0.50; 95% CI 0.29-0.83) after drug-eluting stent implantation.
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