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

Bulluck, Heerajnarain; Kwok, Chun Shing; Ryding, Alisdair; Loke, Yoon K.

doi:10.1016/j.ijcard.2014.12.037

Cited by 21 publications

(8 citation statements)

References 39 publications

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“…Present meta-analysis supports recent findings of studies reporting that S-DAPT significantly reduced major bleeding events without increasing risk of ST, all-cause mortality, MI, cardiac mortality, or cerebrovascular accidents ( 8 , 9 , 22 – 26 , 33 , 34 ). While L-DAPT effectively reduced risk of ST and ischemic events, risk of bleeding increases with longer duration of treatment.…”

Section: Discussionsupporting

confidence: 90%

Efficacy and safety of short-term (≤6 months) duration of dual antiplatelet therapy after drug-eluting stents: a meta-analysis of randomized controlled trials

et al. 2016

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Objective:Optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation remains controversial. The present study is an assessment of efficacy and safety of short-term (≤6 months) DAPT after DES implantation in patients with coronary artery disease, especially in important subgroups.Methods:PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized, controlled trials comparing short-term and long-term (>6 months) DAPT after DES implantation. Primary efficacy outcome was stent thrombosis (ST). Primary safety outcome was major bleeding. Pooled relative risks (RRs) with 95% confidence interval (CI) were calculated using random- or fixed-effects models as appropriate.Results:Total of 7 trials involving 15870 patients were included in the study. Short-term DAPT significantly reduced major bleeding by 49% compared with long-term DAPT (RR 0.51; 95% CI 0.32–0.80; p=0.003) without increasing risk of ST (RR 1.28; 95% CI 0.83–1.97; p=0.266). In addition, no differences were observed in all-cause mortality, myocardial infarction (MI), cardiac mortality, or cerebrovascular accidents. Moreover, no significant difference in composite of cardiovascular events, bleeding, and mortality was found in important clinical subgroups.Conclusion:Short-term DAPT is associated with lower bleeding risk compared with long-term DAPT. Number of ST and MI was higher with short-term DAPT without reaching statistical significance. Comprehensive clinical judgment is necessary to weigh benefits and risks in the individual patient.

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Section: Discussionsupporting

confidence: 90%

Efficacy and safety of short-term (≤6 months) duration of dual antiplatelet therapy after drug-eluting stents: a meta-analysis of randomized controlled trials

et al. 2016

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“…This contributes to the existing evidence that reduced duration DAPT is safe and effective with currently used DES in carefully selected clinical trial populations. . This has been reflected in the European Society of Cardiology guidelines and the recently updated ACC/AHA guidelines that now recommend 3 to 6 months of DAPT in patients with stable CAD .…”

Section: Discussionmentioning

confidence: 99%

Short‐versus long‐term Dual Antiplatelet therapy after drug‐eluting stent implantation in women versus men: A sex‐specific patient‐level pooled‐analysis of six randomized trials

Sawaya

Morice

Spaziano

et al. 2016

Cathet Cardio Intervent

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“…In the DAPT study of patients free of ischemic or bleeding events 12 months after PCI, prolonging DAPT for 30 months lowered the risk of subsequent recurrent ischemic events . However, meta‐analyses of smaller studies suggest no benefit from prolonging DAPT after PCI .…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes in patients with acute coronary syndromes related to prolonging dual antiplatelet therapy more than 12 months after coronary stenting

Wimmer

Dufour

Cho

et al. 2016

Cathet Cardio Intervent

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Objectives To assess the impact of stent type on the risk of death or myocardial infarction (MI) related to dual antiplatelet therapy (DAPT) more than 12 months (prolonged DAPT) versus 12 or less months after PCI for an acute coronary syndrome (ACS). Back ground The recent DAPT study reported lower recurrent ischemic events from prolonged DAPT in patients treated with PCI for an ACS, but was underpowered to determine the impact of stent type. Methods We determined clinical outcomes after PCI for an ACS (median follow-up: DES=26 months, BMS=46 months) in 18,484 patients in the Veterans Affairs system treated with first generation drug-eluting stents (DES) or bare-metal stents (BMS). We used landmark analyses starting 1 year after the index PCI to assess the risk of prolonged DAPT on the primary endpoint of death or MI. Multivariable and propensity models adjusted for confounding. Results There was a significant interaction between stent type and prolonged DAPT for death and MI (P = 0.0036), death (P = 0.054), and major bleeding (P = 0.0013). Patients treated with prolonged DAPT had lower risks of death or MI (HR=0.71, 95% CI = 0.61, 0.82) and death (HR = 0.74, 95%CI = 0.62, 0.89) with DES, but not BMS, and higher risks of major bleeding, particularly with BMS (HR = 1.67, P<0.001) than DES (HR = 1.24, p = 0.01). Conclusions Prolonging DAPT more than 12 months after PCI for ACS only associated with a lower risk of ischemic events in the 1–4 years after PCI in those receiving first generation DES. Stent type may influence the benefit of prolonged DAPT.

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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

Cited by 21 publications

References 39 publications

Efficacy and safety of short-term (≤6 months) duration of dual antiplatelet therapy after drug-eluting stents: a meta-analysis of randomized controlled trials

Efficacy and safety of short-term (≤6 months) duration of dual antiplatelet therapy after drug-eluting stents: a meta-analysis of randomized controlled trials

Short‐versus long‐term Dual Antiplatelet therapy after drug‐eluting stent implantation in women versus men: A sex‐specific patient‐level pooled‐analysis of six randomized trials

Long‐term outcomes in patients with acute coronary syndromes related to prolonging dual antiplatelet therapy more than 12 months after coronary stenting

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