Efficacy and Safety Outcomes of Short Duration Antiplatelet Therapy with Early Cessation of Aspirin Post Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis

Abstract

Background: The optimal duration of dual antiplatelet therapy is a matter of ongoing research. Clinical studies are assessing the optimal duration with the most favourable risk to benefit ratio. The efficacy of P2Y12 receptor inhibitors has been shown comparable to aspirin in preventing recurrent ischaemic events in patients with coronary artery diseases. Objectives: To investigate the outcomes of short-duration dual antiplatelet therapy after PCI with early discontinuation of aspirin while maintaining patients on P2Y12 inhibitor through systematic review and meta-analysis of available literature. Methods: We systematically searched Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. We included randomised controlled studies that measured clinical outcomes of efficacy (mortality and ischaemic events) and safety (bleeding) of short and standard duration dual antiplatelet therapy. The protocol of this study was registered in the International prospective register of systematic reviews PROSPERO registry (CRD42020171468). Results: Four randomised controlled trials were included; GLOBAL LEADERS, SMART-CHOICE, STOPDAPT-2 and TWILIGHT. The total number of patients was 29,089. The safety outcomes showed a significant reduction in major bleeding events with short-duration dual antiplatelet therapy; risk ratio is 0.61 (95% CI 0.38-0.99; z=2,00, p=0.05). There was no difference between short and standard duration dual antiplatelet therapy regarding efficacy outcomes (all-cause death, major adverse cardiovascular events, myocardial infarction, stroke and stent thrombosis). Conclusion: Short-duration dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy after PCI is a feasible option and can be adopted, especially in patients with a high risk of bleeding.

Patient-Related Factors Predicting Stent Thrombosis in Percutaneous Coronary Interventions

“…Interruption was defined as the temporary suspension of anti-platelet treatment owing to a medical emergency, followed by the immediate reinstitution of DAPT within 14 days. DAPT disruptions included DAPT termination because of bleeding or disobedience [1,3,7].…”

“…On the other hand, studies that examined patients who received short-duration DAPT that included aspirin and a P2Y12 inhibitor followed by only a P2Y12 inhibitor did not find any differences between shortand standard-duration DAPT regarding efficacy outcomes (all-cause death, major adverse cardiovascular events (MACE), myocardial infarction, stroke, and ST), but did find that major bleeding events were significantly reduced with short-duration DAPT. Therefore, following PCI, short-term DAPT followed by P2Y12 inhibitor monotherapy is a viable alternative that can be used, especially in patients who have an elevated risk of bleeding [3].…”

“…The etiology of ST is multifactorial, and includes lesion-, patient-, procedural-and stent-related factors. Left main coronary artery or proximal left anterior descending artery lesion, bifurcation or severe calcified lesions and in-stent restenosis are recognized as lesional factors [3]. Procedural factors (incomplete stent apposition, stent underexpansion, residual edge dissection) and stent factors (stent fracture, overlap, long stent length) may thrombosis (after 12 months) nty Definite: ACS with angiographic or autopsy confirmation of ST Probable: Unexplained death within 30 days of stent implantation without autopsy AMI in the territory of a target vessel where stent was implanted but without angiographic confirmation…”

“…The etiology of ST is multifactorial, and includes lesion-, patient-, procedural-and stent-related factors. Left main coronary artery or proximal left anterior descending artery lesion, bifurcation or severe calcified lesions and in-stent restenosis are recognized as lesional factors [3]. Procedural factors (incomplete stent apposition, stent underexpansion, residual edge dissection) and stent factors (stent fracture, overlap, long stent length) may also be associated with ST.…”

“…Shorter DAPT durations after ACS were associated with higher rates of ST and myocardial infarction [8,9]; • No differences between short-duration and standard-duration DAPT in terms of effectiveness results, with short-term DAPT being an option for patients at high risk of bleeding [3]; • A single month of DAPT was non-inferior to the long-term DAPT in terms of the risk of MACE [4,11,13]; • DAPT withdrawal was not linked to poorer 1-year TLF following COMBO stenting [17]; • Younger patients had a higher cardiovascular risk associated with disruption, whereas those over 75 did not [18]; •…”