Key result
Abbreviated dual antiplatelet therapy (≤6 months) significantly reduced major bleeding complications compared to standard duration (≥12 months) (OR 0.52; 95% CI 0.34-0.82; P=0.005).
Why the study?
Does an abbreviated duration of dual antiplatelet therapy (≤6 months) reduce bleeding complications without increasing ischemic events compared to standard-duration therapy (≥12 months) in patients receiving second-generation drug-eluting stents?
Meta-Analysis (n=15,874)
Does an abbreviated duration of dual antiplatelet therapy (≤6 months) reduce bleeding complications without increasing ischemic events compared to standard-duration therapy (≥12 months) in patients receiving second-generation drug-eluting stents?
In patients receiving second-generation DES, an abbreviated DAPT duration of ≤6 months significantly reduces major bleeding without increasing the risk of death, MI, or stent thrombosis compared to standard ≥12-month DAPT.
Answers are grounded in this paper and cite their sources.
Abbreviated DAPT may be preferred after second-generation DES to reduce bleeding; reinforces RCT evidence of ischemic safety.
BACKGROUND: Dual antiplatelet therapy (DAPT) is recommended for ≥12 months following coronary drug-eluting stents (DES) to reduce risk of major adverse ischemic events. Randomized trials suggest an abbreviated DAPT duration (≤6 months) is adequately protective. However, these trials are individually underpowered to detect differences in rare but serious events such as stent thrombosis (ST). OBJECTIVES: We performed a meta-analysis of published randomized trials to define the impact of abbreviated DAPT (≤6 months) on death, myocardial infarction (MI), stent thrombosis (ST), and bleeding complications compared to standard-duration DAPT (≥12 months). METHODS: Seven randomized controlled trials comparing abbreviated vs. standard DAPT regimens following DES use were identified by two independent investigators. Study characteristics were reviewed and clinical endpoint data were abstracted and analyzed in aggregate using fixed and random-effects models. RESULTS: The seven trials included 15,874 randomized patients. Second-generation DES were used in most patients. Compared to standard-duration DAPT, abbreviated DAPT was not associated with an increase in mortality (OR 0.93; CI: 0.73 to 1.17; P = 0.52), MI (OR 1.14; CI: 0.89 to 1.45; P = 0.30) or ST (OR 1.25; CI: 0.81 to 1.93; P = 0.31). Abbreviated DAPT was associated with significantly fewer major bleeding complications (OR 0.52; CI: 0.34 to 0.82; P = 0.005). The results were consistent between fixed and random-effects models, with no heterogeneity. Sensitivity analyses adjusting for inclusion of bare metal stents, 1st generation DES and/or abbreviated DAPT regimens of 3 months resulted in similar conclusions. CONCLUSIONS: In a meta-analysis of >15,000 patients primarily treated with second-generation DES, abbreviated-duration DAPT (≤6 months) was associated with a significant reduction in major bleeding complications with no evidence of a significant increase in risk of death, MI or ST. Accordingly, abbreviated DAPT should be strongly considered for patients receiving second generation DES.
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Ziada et al. (2015) conducted a meta-analysis in coronary artery disease (n=15,874). Abbreviated dual antiplatelet therapy vs. Standard-duration dual antiplatelet therapy was evaluated on major bleeding complications (OR 0.52, 95% CI 0.34-0.82, p=0.005). Abbreviated dual antiplatelet therapy (≤6 months) significantly reduced major bleeding complications compared to standard duration (≥12 months) (OR 0.52; 95% CI 0.34-0.82; P=0.005).
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