Duration of Dual Antiplatelet Treatment After Percutaneous Coronary Intervention in Patients With Diabetes: A Systematic Review and Meta-analysis

Abstract

Aim of our systematic review and meta-analysis is to compare shortened (≤3 months) dual antiplatelet therapy (DAPT) with longer DAPT in diabetic patients undergoing percutaneous coronary interventions (PCI). We systematically screened three major databases (Medline, Cochrane Central Register of Controlled Trials and Scopus) searching for randomized-controlled trials or sub-analyses of them, which compared shortened (S-DAPT) to longer (L-DAPT) regimens of DAPT. Primary endpoint of systematic review and meta-analysis is the NACE (Net Adverse Cardiac Events) and secondary are MACE (Major Adverse Cardiac Events), mortality, bleedings, myocardial infarction and stent thrombosis. Subgroup analyses included studies using only ticagrelor-based regimens and three-months duration of DAPT. A total of eight studies and 12,665 patients were included in our analysis. Our meta-analysis met its primary endpoint, as S-DAPT was associated significantly with a reduced risk ratio (RR) by 17% [RR: 0.83, 95% Confidence Intervals (CI): 0.72-0.96]. Non-significant difference among the rest endpoints was detected between the two groups. Subgroup analyses showed that ticagrelor-based regimens were associated with a significant reduction of mortality (RR: 0.67, 95% CI: 0.48-0.93) and three-months DAPT reduced furtherly NACE by 27% (RR:0.73, 95% CI: 0.60-0.89). In conclusion, our systematic review and meta-analysis showed that (i) S-DAPT was significantly associated with a lower incidence of NACE, (ii) ticagrelor-based S-DAPT was associated with decreased mortality rates, and (iii) the benefit of three-months duration of DAPT achieved an even greater NACE reduction. Thus, S-DAPT could be considered as a safe and feasible option in diabetic patients.

Efficacy and Safety of Thirty-Day Dual-Antiplatelet Therapy Following Complex Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

“…The clinical advantages of DAPT duration shortening have been substantiated in meta-analyses encompassing both individuals at high and low risk of bleeding events. As previously shown, one-month DAPT reduces major bleedings by 22% (OR: 0.78, 95% Cl: 0.65-0.94) and one or three months of DAPT by 29% (OR 0.71, 95% Cl 0.61-0.82), without having a negative impact on mortality, composite outcomes, or ischemic events, respectively [8,20,53,54]. Nonetheless, the benefits are more pronounced in high-risk bleeding patients, as evidenced by the results of two recent meta-analyses.…”

“…The risk of ischemic events following percutaneous coronary intervention (PCI) is directly proportional to the complexity of the procedure, owing to both anatomical and technical factors [5][6][7]. Moreover, patient characteristics, like diabetes mellitus, active cancer, or tobacco smoking, could lead to an increased risk for ischemic events [8][9][10]. However, an extended duration of dual-antiplatelet therapy (DAPT) has been shown to increase the risk of major bleeding, which is associated with elevated rates of morbidity and mortality [11][12][13].…”