Beneficial Impact of Prolonged Dual Antiplatelet Therapy after Drug‐Eluting Stent Implantation

Abstract

In this retrospective registry, patients with off-label DES implantation receiving prolonged (>12 months) DAT presented with lower rates of MACCE and myocardial infarction.

Should a prolonged duration of dual anti-platelet therapy be recommended to patients with diabetes mellitus following percutaneous coronary intervention? A systematic review and meta-analysis of 15 studies

“…Ten studies were further eliminated since they were meta-analyses, 11 studies were case studies, 2 studies were protocol of future ongoing trials, 6 articles were letter to editors, and 10 articles were associated with the same trial. Finally, 15 studies (Brar2008 [12], I-LOVE IT 2 [13], ISAR-SAFE [14], Tarantini2016 [15], ARCTIC [16], OPTIMIZE [17], RESET [18], EXCELLENT [3], PEGASUS [19], DAPT [20], Sardella2011 [21], PRODIGY [22], Thukkani2015 [23], ENDEAVOR [24], ITALIC [25]) that satisfied all the inclusion and exclusion criteria of this current analysis, were included. The flow diagram representing the study selection has been illustrated in Fig.…”

Discontinuation of Dual Antiplatelet Therapy Over 12 Months after Acute Coronary Syndromes Increases Risk for Adverse Events in Patients Treated with Percutaneous Coronary Intervention: Systematic Review and Meta‐Analysis

“…The previous outlined combined risk of disease progression on natural vessels and of increased hazard of ST may explain the differences between our results and previous reported studies, which did not focus specifically on ACS patients treated with PTCA. Many observational studies investigating both stable and unstable patients undergoing stenting reported either positive or neutral results, while randomized clinical trials and the meta‐analysis of Cassese et al did not report a benefit of increased duration of DAPT. However, our results are consistent with the CHARISMA trial, in particular for the subgroup analysis on patients with previous ischemic heart disease: after 2 years, more than 1% reduction in recurrent events was offered by duration of clopidogrel for more than 1 year.…”

Systematic review of the clinical impact of dual antiplatelet therapy discontinuation after acute coronary syndromes

“…32 When DAPT was discontinued on the physician’s initiative, the duration of treatment before discontinuation ranged from 1 month to 2 years. 8,9,11,14–16,18,19,23,26,27,34,36…”

“…Four studies reported comparative data on cardiovascular mortality (see Supplementary Table 3 online), three of which provided risk analyses (Figure 3). 9,19,27,36…”