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September 22, 2022Coronary Artery Disease

Short dual antiplatelet therapy in patients with high bleeding risk undergoing percutaneous coronary intervention: a systematic review and meta-analysis

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Why the study?

The efficacy and safety of an abbreviated duration of dual antiplatelet therapy in patients with high bleeding risk undergoing percutaneous coronary intervention remain controversial.

Does shortened dual antiplatelet therapy (1, 3, or 6 months) reduce bleeding without increasing ischemic events in patients with high bleeding risk undergoing percutaneous coronary intervention?

Comparison

Abbreviated DAPT durations (1, 3, and 6 months) vs longer DAPT durations (>1, >3, and >6 months)

Design

Systematic review and meta-analysis

Authors

JZJunyan ZhangZCZhongxiu ChenCLChen Li

Discussion

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Overview

Supports tailored short DAPT in HBR-PCI now; confirms 1- and 6-month safety while leaving 3-month ischemic risk open.

Key Points

  • To assess the efficacy and safety of shortened dual antiplatelet therapy (DAPT) durations in patients with high bleeding risk undergoing percutaneous coronary intervention.
  • Systematic review and meta-analysis searching Cochrane Library, PubMed, EMBASE, and Ovid MEDLINE databases across 9 studies comprising 10 cohorts.
  • Evaluated major adverse cardiac events (MACE) and net adverse clinical events (NACE) across stratified DAPT regimens of 1, 3, and 6 months versus longer durations in high-bleeding-risk patients.
  • A 1-month DAPT regimen demonstrated comparable risks of NACE and MACE compared to regimens lasting longer than 1 month.
  • A 3-month DAPT regimen did not increase MACE but was associated with increased risks of ischemic stroke and stent thrombosis compared to regimens >3 months.
  • A 6-month DAPT regimen significantly reduced the risk of major bleeding without increasing NACE or MACE compared to regimens >6 months.

Structured PICO

Does shortened dual antiplatelet therapy (1, 3, or 6 months) reduce bleeding without increasing ischemic events in patients with high bleeding risk undergoing percutaneous coronary intervention?

P
Population
Patients with high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) (9 studies, 10 cohorts)
I
Intervention
Shortened dual antiplatelet therapy (DAPT) duration (1, 3, and 6 months)
C
Comparator
Longer dual antiplatelet therapy (DAPT) duration (>1, >3, and >6 months)
O
Outcome
Incidences of major adverse cardiac events (MACE) and net adverse clinical events (NACE)composite

In high bleeding risk patients undergoing PCI, 1- or 6-month DAPT appears safe regarding MACE, with 6-month DAPT reducing major bleeding, though 3-month DAPT may increase ischemic stroke risk.

Cite This Study

Zhang et al. (2022) studied this question.

synapsesocial.com/papers/6a7fbc75044998269cd772ebhttps://doi.org/10.1097/mca.0000000000001180
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