Key result
Short DAPT cuts major bleeding ~42% vs. long DAPT after DES without increasing ischemic events.
Why the study?
The optimal duration of dual antiplatelet therapy after drug-eluting stent implantation remains controversial and inadequately powered in individual trials.
Meta-Analysis (n=19,099)
Open-label
Randomized
Yes
Relative Risk: 0.58 (95% CI 0.39–0.86)
Absolute Event Rate: 0.62% vs 1.1%
p-value: p=<0.007
May support shorter DAPT post-DES to lower bleeding risk; reinforces trial consensus for tailored durations.
BACKGROUND: Dual antiplatelet therapy (DAPT) remains the cornerstone therapy in the prevention of ischaemic events following drug-eluting stent (DES) implantation. Mandatory duration of DAPT after DES however, is a matter of debate. We aimed to evaluate safety and efficacy of short-term (up to 6 months) versus long-term (12 months) DAPT after DES implantation. METHODS: We searched PubMed, EMBASE, Cochrane databases, and international meetings for randomised clinical trials (RCTs) comparing short with long DAPT. We performed a systematic review and meta-analysis of major trials with primary outcomes: all-cause death, myocardial infarction, definite or probable stent thrombosis, stroke, and major bleeding event. RESULTS: = 21%), whereas all-cause death (1.65% vs. 1.84%, RR 0.90, 95% CI 0.73 to 1.11, p = 0.34, I2 = 0%), myocardial infarction (1.91% vs. 1.68%, RR 1.14, 95% CI 0.92 to 1.40, p = 0.23, I2 = 0%), definite or probable stent thrombosis (0.62% vs. 0.47%, RR 1.25, 95% CI 0.84 to 1.86, p = 0.27, I2 = 0%), and stroke (0.60% vs. 0.67%, RR 0.91, 95% CI 0.63 to 1.31, p = 0.61, I2 = 0%) were similar. CONCLUSIONS: Short DAPT following DES implantation results in a significant reduction of major bleeding events with no apparent increase in all-cause death, myocardial infarction, stent thrombosis, or stroke. Future dedicated trials should investigate the optimal strategies for patient-tailored DAPT in various subgroups.
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Rozemeijer et al. (2018) conducted a meta-analysis in Coronary artery disease requiring drug-eluting stent implantation (n=19,099). Short duration dual antiplatelet therapy vs. Long duration dual antiplatelet therapy (≥12 months) was evaluated on Major bleeding events (RR 0.58, 95% CI 0.39 to 0.86, p=<0.007). Short dual antiplatelet therapy (up to 6 months) following drug-eluting stent implantation significantly reduced major bleeding events (RR 0.58) compared to long therapy, without increasing ischemic events.
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