Optimal Duration of Dual Antiplatelet Therapy After Drug-eluting Stent Implantation

Abstract

The results indicate that short-term DAPT do not increase the risk of cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, major bleeding, cerebrovascular accidents, and all-cause death at 12 months after implantation of DES compared with current standard-term DAPT. However, only 3 studies with second generation of DES are included in this meta-analysis. Further well-designed studies are still needed.

Short- versus standard-term dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent implantation: A meta-analysis

“…A meta-analysis published in 2014 compared shorter (3-6 months) to standard (12 months) DAPT therapy [19]. Similar to the present analysis, this study did not find a statistically significant difference in all-cause and cardiac death, MI, or stent thrombosis.…”

“…EXCELLENT [13] RESET [14] OPTIMIZE [15] SECURITY [16] ITALIC [18] ISAR-SAFE [19] Year 2012 2012 2013 2014 2015 2015 Design R, MC, OL R, MC, OL R, MC, OL R, MC, OL R, MC, Plasminogen Activator for Occluded Coronary Arteries (GUSTO) criteria in one study. Major bleeding was an absolute 0.25% lower with shorter-term DAPT (0.32% versus 0.57%, OR 0.58, 95% CI 0.34-0.98, I 2 = 0%) ( Fig.…”

Safety of short-term dual antiplatelet therapy after drug-eluting stents: An updated meta-analysis with direct and adjusted indirect comparison of randomized control trials

“…First of all we included high quality RCTs only, totaling > 16000 patients, which has more power that previous meta-analyses of RCTs only conducted on this topic 12,26,34,35 . Secondly, our previous work 12 However, in this rapidly evolving field, it is inevitable that the stent platform with continue to change in the current ongoing and future trials.…”

“…These make the conduct of a large-scale RCT that could potential stratify for all confounding factors very difficult and the result of such a trial may become obsolete once it is finally published because of the constant evolution in technology and pharmacology. Therefore, in an attempt to update the current evidence on this topic, there have been a number of meta-analyses 12,26,[33][34][35] conducted over the last few years. Our meta-analysis, to our knowledge, is the most upto-date and summarizes all the relevant RCTs to date.…”

Optimal duration of dual antiplatelet therapy following percutaneous coronary intervention: protocol for an umbrella review

“…The association between DAPT duration and clinical outcomes has been assessed in many systematic reviews and meta-analyses,5–8 yet the optimal duration of DAPT remains a controversial topic. Previous meta-analyses have reported an increased risk of death among patients who received DAPT for more than 12 months following stenting, yet extending DAPT beyond 12 months may reduce the risk of myocardial infarction (MI) and stent thrombosis 6…”