Why the study?
Abbreviating dual antiplatelet therapy duration to one or three months has been recently proposed after PCI with drug-eluting stents, particularly for patients at high bleeding risk.
Does 30-days DAPT reduce major bleeding and net adverse clinical events compared to longer duration DAPT in patients undergoing PCI with DES?
Does 30-days DAPT reduce major bleeding and net adverse clinical events compared to longer duration DAPT in patients undergoing PCI with DES?
Answers are grounded in this paper and cite their sources.
Shortening DAPT to 30 days after PCI with newer DES significantly reduces major bleeding without increasing the risk of ischemic events or mortality.
Abbreviation of the duration of dual antiplatelet therapy (DAPT) (one or three months) has been recently proposed, especially for high bleeding risk patients, after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Three databases were screened for eligible randomized control trials. The primary endpoint was the incidence of net adverse clinical events (NACE). Secondary endpoints consisted of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infarction, stroke, stent-thrombosis, repeat revascularization and major bleeding. We included four RCTs with a total of 26,576 patients; 13,282 patients were grouped in 30-days DAPT, while the remaining 13,294 were allocated in a longer period of DAPT. One month of DAPT did not significantly reduce NACE (odds ratio [OR]: 0.87, 95% confidence intervals [Cl]: 0.74-1.03); however, major bleedings were significantly reduced by 22% (OR: 0.78, 95% Cl: 0.65-0.94). Mortality or ischemic events (stroke, myocardial infarction, revascularization and stent thrombosis) were not affected. Thus, 30-days DAPT could be considered as safe and feasible after PCI with DES in selected patients, especially those with high bleeding risk. Forthcoming RCTs could shed light on the optimal duration of DAPT.
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Tsigkas et al. (2023) studied this question.
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