Safety and efficacy of short-term (1 to 3 months) dual antiplatelet therapy in patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials

Kheiri, Babikir; Simpson, Timothy F.; Golwala, Harsh; Radaideh, Qais; Kumar, Kris; Rahmouni, Hind; Divanji, Punag; Cigarroa, Joaquin E.; Zahr, Firas

doi:10.1007/s11239-020-02069-9

Cited by 9 publications

(11 citation statements)

References 15 publications

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“…[21] In our study, the results revealed that compared with the standard DAPT, the short-term DAPT could reduce the risk of major bleeding and all bleeding events, which is consistent with other research results. [10,[22][23][24] However, there was a significant heterogeneity in the results of major bleeding risks. Sensitivity analysis indicated that the heterogeneity was significantly reduced after the exclusion of the GLASSY study, and the results demonstrated that the main bleeding risk was still statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Short-term (1–3 months) versus standard (12 months) dual antiplatelet therapy following new-generation drug-eluting stent implantation: A meta-analysis of randomized controlled trials

Xiong,

Zheng,

Fan

et al. 2024

Medicine

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Background: Patients undergoing percutaneous coronary intervention mainly receive antiplatelet therapy. However, limited data are available regarding the optimal dual antiplatelet therapy (DAPT) following the implantation of new-generation drug-eluting stent (DES). Objective: This study aimed to compare the clinical outcomes of short-term (1–3 months) DAPT and standard (12 months) DAPT after the implantation of a new-generation of DES. Methods: We systematically searched PubMed, The Cochrane Library Database, Embase for trials that compared short-term (1–3 months) and standard DAPT after the implantation of next-generation DES were retrieved from all published studies in English until December 31, 2021. The primary endpoint was major bleeding. The secondary endpoints included all-cause mortality, cardiac death, myocardial infarction, stroke, stent thrombosis, and all bleeding. Results: This study included a total of 7 randomized controlled trials, comprising 28,344 subjects. Regarding primary endpoints, short-term DAPT exhibited a significantly lower incidence of major bleeding compared with standard DAPT [relative risk (RR): 0.66, 95% confidence interval (CI): (0.54, 0.81), P < .0001]. For secondary endpoints, there were significant differences between short-term and standard DAPT in all bleeding [RR: 0.59, 95% CI: (0.50, 0.69), P < .00001]. However, no significant differences were identified in all-cause mortality [RR: 0.96, 95% CI: (0.77, 1.18), P = .27], myocardial infarction [RR: 0.98, 95% CI: (0.82, 1.18), P = .86], cardiac death [RR: 0.83, 95% CI: (0.63, 1.10), P = .20], stroke [RR: 1.08, 95% CI: (0.79, 1.47), P = .63], cerebrovascular [RR: 1.08, 95% CI: (0.79, 1.47), P = .63], and stent thrombosis [RR: 1.13, 95% CI: (0.80, 1.57), P = .49] between the 2 groups. Conclusion: In patients undergoing implantation of a new-generation of DES, short-term (1–3 months) DAPT exhibited no inferiority compared with standard (12 months) DAPT in terms of all-cause mortality, cardiac death, myocardial infarction, stroke, and definite or probable stent thrombosis compared with standard (12 months) DAPT. However, short-term DAPT appeared superior to standard DAPT in terms of major bleeding and all bleeding.

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Section: Discussionmentioning

confidence: 99%

Short-term (1–3 months) versus standard (12 months) dual antiplatelet therapy following new-generation drug-eluting stent implantation: A meta-analysis of randomized controlled trials

Xiong,

Zheng,

Fan

et al. 2024

Medicine

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“…Optimal DAPT duration is still a matter of concern, with new evidence supporting shortened DAPT, especially in patients with a high risk of bleeding 1 . Recent meta‐analyses of RCTs comparing short DAPT (≤3 months) and standard DAPT (12 months) showed that short DAPT was associated with a lower risk of bleeding without a significantly increased risk of ischaemic events 16,17 . Another meta‐analysis found that de‐escalation DAPT with a switch from prasugrel or ticagrelor to clopidogrel after short duration DAPT compared to the standard continuation of therapy was associated with a reduction in the net clinical number of thrombotic or bleeding events similar to that which was found in our meta‐analysis 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Several randomized clinical trials (RCTs) have shown that a shorter DAPT duration (1–3 months) followed by single antiplatelet therapy was associated with a lower risk of bleeding compared to standard DAPT 8–15 . A meta‐analysis of RCTs has supported the reduction of DAPT duration 16,17 . On the basis of previous studies, current European guidelines have recommended that a shortened DAPT duration of 1–3 months should be considered in patients with a high risk of bleeding (e.g., the predicting bleeding complication in patients undergoing stent implantation and subsequent [PRECISE] DAPT ≥ 25 or academic research consortium for high bleeding risk [ARC‐HBR] criteria met) after stent implantation 1 .…”

Section: Introductionmentioning

confidence: 99%

“… 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 A meta‐analysis of RCTs has supported the reduction of DAPT duration. 16 , 17 On the basis of previous studies, current European guidelines have recommended that a shortened DAPT duration of 1–3 months should be considered in patients with a high risk of bleeding (e.g., the predicting bleeding complication in patients undergoing stent implantation and subsequent [PRECISE] DAPT ≥ 25 or academic research consortium for high bleeding risk [ARC‐HBR] criteria met) after stent implantation. 1 A previous meta‐analysis of RCTs demonstrated that de‐escalation DAPT showed a significantly lower number of thrombotic or bleeding events than standard DAPT.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis

Wongsalap

Kengkla

Wilairat

et al. 2023

Chronic Diseases and Translational Medicine

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BackgroundDual antiplatelet therapy (DAPT) is key for preventing ischaemic events post‐percutaneous coronary intervention (PCI). Various DAPT modifications like the shortened duration or P2Y12 inhibitor (P2Y12i) de‐escalation are implemented to reduce bleeding risk. However, these strategies lack direct comparative studies. This study aimed to assess the efficacy and safety of such DAPT strategies, including de‐escalated and short DAPT, in patients undergoing PCI.MethodsWe searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for relevant randomized controlled trials (RCTs). We performed a network meta‐analysis (NMA) to estimate risk ratios (RRs) and 95% confidence intervals (CIs). The primary efficacy endpoint was major adverse cardiac events (MACEs), and the primary safety endpoint was major bleeding. Secondary endpoints included individual components of MACEs and net adverse clinical events (NACEs).ResultsA total of 17 RCTs comprising 53,156 patients (median age, 62.0 years, 24.8% female) were included. NMA suggested that de‐escalation DAPT was associated with a significantly lower risk of MACEs (risk ratio [RR] = 0.79, 95% confidence interval [CI] = 0.64–0.98), bleeding (RR = 0.63, 95% CI = 0.49–0.82), and NACEs (RR = 0.69, 95% CI = 0.60–0.79) compared with standard DAPT. Short DAPT followed by P2Y12i monotherapy exhibited a significantly decreased risk of major bleeding (RR = 0.63, 95% CI = 0.46–0.86) compared with standard DAPT.ConclusionsDe‐escalation DAPT was the most effective strategy for preventing the risk of MACEs without increasing bleeding events, while short DAPT followed by P2Y12i monotherapy was the most effective strategy for reducing the risk of bleeding among patients undergoing PCI.

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“…Thrombosis formation in patients with CAD remains life-threatening, with high morbidity and mortality ( Bentzon et al, 2014 ). Platelet inhibitors are essential in the treatment and secondary prevention of patients with CAD following PCI ( Kheiri et al, 2020 ). For several years, dual antiplatelet therapy remained the cornerstone of reduced major adverse cardiac events ( Capodanno et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Novel Tool for the Prediction of Clopidogrel Response in Chinese Acute Coronary Syndrome Patients: The GeneFA Score

Qian

et al. 2022

Front. Pharmacol.

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Aim: Growing evidence indicated that CYP2C19 genotypes could only explain a fraction of the pharmacodynamic response to clopidogrel, while a number of clinical factors also have contributing roles. Our objective was to develop a new risk score to improve prognostication of ischemic events in Chinese patients treated with clopidogrel.Methods: A new risk score was developed and internally validated in 445 patients with acute coronary syndrome (ACS) undergoing coronary stenting. The final score was named the GeneFA score based on the inclusion of CYP2C19 genotype, fibrinogen, and age. External validation of the GeneFA score and comparison with the ABCD-GENE score were performed in an independent ACS cohort.Results: Based on the observed frequencies of high platelet reactivity (HRPR) in relation to the GeneFA risk score, a relatively higher clinical HRPR was observed in the upper quintile with a representative score of 3 (52.90%) and 4 (59.10%), whereas it was found less frequently in groups with scores 0 (6.70%), 1 (15.10%), and 2 (16.70%). Participants with a GeneFA score >2 had an increased risk of HRPR (54.3 vs. 14.7%, p < 0.001) and ischemic recurrence (20.7 vs. 5.4%, p < 0.001). The GeneFA score exhibited a better prediction for high HRPR patients as compared to the ABCD-GENE score (p < 0.001). In the validation population, GeneFA illustrated a similarly high prognostic value for HRPR incidence (C-statistic: 0.855 for GeneFA and 0.843 for ABCD-GENE) and ischemic recurrence (C-statistic: 0.726 for GeneFA and 0.724 for ABCD-GENE) on clopidogrel as compared to ABCD-GENE.Conclusion: The GeneFA risk score had a moderate predictive ability for HRPR on clopidogrel for CAD patients in Chinese populations. The predictive value of the GeneFA score was consistent with the ABCD-GENE score for HRPR identification.

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Safety and efficacy of short-term (1 to 3 months) dual antiplatelet therapy in patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials

Cited by 9 publications

References 15 publications

Short-term (1–3 months) versus standard (12 months) dual antiplatelet therapy following new-generation drug-eluting stent implantation: A meta-analysis of randomized controlled trials

Short-term (1–3 months) versus standard (12 months) dual antiplatelet therapy following new-generation drug-eluting stent implantation: A meta-analysis of randomized controlled trials

Efficacy and safety of different dual antiplatelet strategies in patients undergoing percutaneous coronary intervention: A systematic review and network meta‐analysis

Development and Validation of a Novel Tool for the Prediction of Clopidogrel Response in Chinese Acute Coronary Syndrome Patients: The GeneFA Score

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