Key result
Short-term DAPT matches long-term therapy for composite events post-DES but reduces major bleeding.
Why the study?
The optimal duration of dual antiplatelet therapy following drug-eluting stent implantation remains debated.
Does short-term (≤ 6 months) dual antiplatelet therapy reduce adverse events or bleeding compared to long-term (≥ 12 months) therapy in patients receiving percutaneous coronary intervention with drug-eluting stents?
Meta-Analysis (n=15,378)
Open-label (mostly)
Yes
Yes
Does short-term (≤ 6 months) dual antiplatelet therapy reduce adverse events or bleeding compared to long-term (≥ 12 months) therapy in patients receiving percutaneous coronary intervention with drug-eluting stents?
Relative Risk: 1.017 (95% CI 0.872–1.186)
Absolute Event Rate: 4% vs 4%
Short-term DAPT (≤ 6 months) following DES implantation is as effective as long-term DAPT (≥ 12 months) in preventing ischemic events but significantly reduces the risk of major bleeding.
Short-term DAPT after DES may be preferred to cut major bleeding without ischemic harm; reinforces abbreviated regimens in guidelines.
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) following drugeluting stent (DES) implantation remains a subject of an ongoing debate. METHODS: MEDLINE, EMBASE, Scopus and CENTRAL databases were searched for eligible randomized controlled trials (RCTs) that compared short-term (￡ 6 months) DAPT with long-term (≥ 12 months) DAPT following DES implantation. The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), stroke, or major bleeding. The secondary outcome were the individual components of the primary outcome, cardiovascular death, stent thrombosis and any bleeding episode. RESULTS: A total of 15,378 patients from 7 RCTs were studied. There were no statistically significant differences between the short-term and long-term DAPT groups with respect to the occurrence of the primary outcome (risk ratio [RR] 1.017; 0.872-1.186; I2 = 0%), all cause death (RR 0.896; 0.708-1.134), cardiovascular death (RR 0.924; 0.668-1.279), MI (RR 1.139; 0.887-1.461), TVR (RR 1.174; 0.916-1.505), stent thrombosis (RR 1.264; 0.786-2.032), and stroke (RR 0.876; 0.685-1.611). However, there was a statistically significant lower risk of major bleeding in the short-term DAPT group (RR 0.57; 0.36-0.90; p = 0.02). There were no statistically significant differences in the sub-group analysis of patients with diabetes and patients presenting with acute coronary syndrome, RR 1.029; 0.745-1.421 and RR 1.062; 0.785-1.438, respectively. CONCLUSIONS: There was no difference in efficacy outcomes between short-term and long-term DAPT following DES, even among high-risk patients. However, longer duration of DAPT was found to be associated with increased risk of major bleeding.
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Sheyin et al. (2015) conducted a meta-analysis in Patients receiving percutaneous coronary intervention with drug-eluting stents (n=15,378). Short-term (≤ 6 months) dual antiplatelet therapy vs. Long-term (≥ 12 months) dual antiplatelet therapy was evaluated on Composite of all-cause mortality, myocardial infarction, target vessel revascularization, stroke, or major bleeding (RR 1.017, 95% CI 0.872-1.186). Short-term dual antiplatelet therapy (≤ 6 months) showed no significant difference in the composite primary outcome compared to long-term therapy (≥ 12 months) following drug-eluting stent implantation (RR 1.017), but significantly reduced the risk of major bleeding.
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