Key result
Long-term dual antiplatelet therapy significantly increased the risk of major bleeding (OR 2.37) compared to short-term therapy followed by P2Y12 monotherapy in patients after percutaneous coronary intervention.
Why the study?
The study evaluated the efficacy and safety of different DAPT strategies after PCI with drug-eluting stents.
Does short-term DAPT followed by P2Y12 monotherapy reduce bleeding without increasing ischemic events compared to longer DAPT durations in adults with CAD after PCI with DES?
Meta-Analysis (n=81,376)
Does short-term DAPT followed by P2Y12 monotherapy reduce bleeding without increasing ischemic events compared to longer DAPT durations in adults with CAD after PCI with DES?
Short-term DAPT followed by P2Y12 inhibitor monotherapy offers a superior safety profile by reducing bleeding risks without significantly increasing ischemic harm compared to prolonged DAPT strategies after PCI with DES.
Supports short DAPT plus P2Y12 monotherapy to lower bleeding post-PCI; confirms safety advantage in large meta-analysis.
Background: This network meta-analysis was committed to evaluating 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 two of the following DAPT strategies: long-term (>12 months) DAPT (L-DAPT), 12-months DAPT (DAPT 12Mo), short-term (≤6 months) DAPT followed by aspirin monotherapy (S-DAPT+ASA), short-term DAPT followed by a P2Y12 receptor inhibitor monotherapy (S-DAPT+P2Y12) were searched. Primary outcomes were all-cause mortality, cardiac death, myocardial infarction (MI), stroke, major bleeding, any bleeding, definite or probable stent thrombosis (ST). This Bayesian network meta-analysis was performed with the random-effects model. Results: Twenty-four RCTs (n=81,376) were included. L-DAPT increased the risk of major bleeding (OR 2.37, 95%CI 1.32-5.03 compared with S-DAPT+P2Y12) and any bleeding (OR 2.95, 95%CI 1.91-4.34 compared with S-DAPT+P2Y12). When compared with L-DAPT, DAPT 12Mo (OR 1.54, 95%CI 1.13-2.02) and DAPT+ASA (OR 1.67, 95%CI 1.22-2.19) were associated with higher rates of MI, but S-DAPT+P2Y12 obtained no statistical difference. The sensitivity analysis revealed that the risks of major bleeding and any bleeding further increased for ≥18 months of DAPT. In the subgroup analysis, short-term DAPT (S-DAPT) presented similar efficacy and safety to DAPT 12Mo for patients with the acute coronary syndrome (ACS), and lower risks of major bleeding and all-cause mortality were observed in S-DAPT+P2Y12 among patients with newer-generation DES. Conclusions: S-DAPT+P2Y12 presented superiority in patients with all clinical presentations, for a lower risk of bleeding and not associated with increased ischemic harm. Besides, prospective research between aspirin monotherapy and P2Y12 monotherapy was required.
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Xu et al. (2020) conducted a meta-analysis in Coronary artery disease after percutaneous coronary intervention with drug-eluting stents (n=81,376). Long-term dual antiplatelet therapy (>12 months) vs. Short-term dual antiplatelet therapy (≤6 months) followed by P2Y12 monotherapy was evaluated on Major bleeding (OR 2.37, 95% CI 1.32-5.03). Long-term dual antiplatelet therapy significantly increased the risk of major bleeding (OR 2.37) compared to short-term therapy followed by P2Y12 monotherapy in patients after percutaneous coronary intervention.
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