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

Basaraba, Jade E.; Barry, Arden R.

doi:10.1016/j.jjcc.2016.07.021

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…In patients with acute coronary syndromes, short duration of DAPT was associated with an increasing risk of target vessel revascularization and lower rate of bleeding compared with long-term DAPT after DES [21][22][23]. However, there was no significant difference in the rate of all-cause mortality, cardiac mortality, and stroke [24,25]. The study to explore efficacy and safety of DAPT in CKD patients with PCI was limited.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Prolonged Antiplatelet Therapy after Percutaneous Coronary Intervention in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Zhang¹,

Li²,

Wang³

2022

Blood Purif

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Background: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is not established in chronic kidney disease (CKD) patients. Objective: In this meta-analysis, we evaluated the efficacy and safety of long duration DAPT compared with short duration DAPT in CKD patients after PCI. Methods: We searched PubMed, Cochrane, and Embase to identify studies assessing the effect of DAPT duration in CKD patients with PCI. Endpoints included all-cause mortality, major adverse cardiovascular events (MACE), death or myocardial infarction (MI), revascularization, and bleeding. Event rates were compared with a random-effects model expressed by odds ratio (OR) and 95% confidence interval (CI). Results: Six studies were included. CKD patients with extended DAPT duration were at a lower risk of mortality (OR 1.40, 95% CI: 1.11–1.77), MACE (OR 1.33, 95% CI: 1.17–1.51), mortality or MI (OR 1.24, 95% CI: 1.10–1.40), and stroke (OR 1.28, 95% CI: 1.05–1.56). However, there was no significant difference in revascularization and bleeding events between the two groups. Mortality was higher in patients with dialysis or drug-eluting stent comparing short- to long-term DAPT. Conclusions: Prolonged DAPT might decrease the risk of mortality, MACE, and stroke in patients with CKD without any significant difference in bleeding or revascularization. Additional studies are required to determine whether long-term DAPT could be considered for most CKD patients after PCI.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Prolonged Antiplatelet Therapy after Percutaneous Coronary Intervention in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Zhang¹,

Li²,

Wang³

2022

Blood Purif

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“… 4 5 8 More recently, other meta-analyses did not find a statistically significant increase in all-cause mortality. 27 28 Most of these meta-analyses warranted further research with extended DAPT.…”

Section: Discussionmentioning

confidence: 99%

Dissemination of 2014 dual antiplatelet therapy (DAPT) trial results: a systematic review of scholarly and media attention over 7 months

Sharp

Haneef

Ravaud³

et al. 2017

BMJ Open

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ObjectiveTo explore how the results from the 2014 dual antiplatelet therapy (DAPT) trial were disseminated to the scientific community and online media.DesignA a systematic review of scholarly and public attention surrounding the DAPT study.SettingsData were collected from the ISI Web of Knowledge, Google Scholar, PubMed Commons, EurekAlert, the DAPT study website (www.daptstudy.org) and the New England Journal of Medicine website (for scholarly attention) and Altmetric Explorer, Snap Bird, YouTube (for public attention) citing DAPT study results appearing from 16 November 2014 to 10 June 2015.ParticipantsNo participants were involved in this study.Main outcome measureProportion of contents highlighting the increased risk of mortality and critical to the author’s interpretation of the results.ResultsWe identified 425 items reported by seven sources; 164 (39%) disseminated the authors’ interpretation via an electronic link or a reference, with no additional text. Among 81 items (19 %), the message favoured prolonged treatment and consequently overstated the article conclusions. Among 119 items (28 %), the text was uncertain about the benefit of prolonged treatment but was reported with no or inappropriate mention of increased risk of mortality. Only 34 items (8 %) were uncertain about the benefit of prolonged treatment and mentioned increased risk of mortality. In all, 27 items (6 %) did not favour prolonged treatment, and only 12 of these (3 %) clearly raised some concerns about the reporting of increased risk of death.ConclusionDissemination of the DAPT study results to the scientific community and on different media sources rarely criticised the interpretation of the study results.

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“…DAPT is recommended for six months in patients with stable angina following PCI, with exceptions made if there is a high risk of fatal bleeding -e.g. previous bleeding episode, bleeding diatheses [18] -which may require dose alteration after one to three months. For ACS patients, DAPT is continued for 12 months, with the exception of cases with a risk of fatal bleeding, where therapy duration is reduced to six months [3].…”

Section: Predictorsmentioning

confidence: 99%

“…It consists of a combination of aspirin with an oral inhibitor of the platelet P2Y12 receptor for adenosine 5'diphosphate (ADP). Given the high risk of LST with DES, the current standard of practice requires a DAPT duration of 12 months, especially in ACS patients undergoing PCI [18]. Studies favoring DAPT prolongation beyond 12 months after MI or after PCI suggest the potential advantage of reduced future spontaneous MI risk which is otherwise associated with a 15% mortality rate in these patients [8].…”

Section: Table 10: Outcomes Of Stmentioning

confidence: 99%

Identifying the Incidence, Predictors, Outcomes, and Prevention of Stent Thrombosis (ST) in Post-percutaneous Coronary Revascularization Patients With Drug-Eluting Stents (DES): A Systematic Review

Sohail,

Patel,

Midha

et al. 2023

Cureus

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Stent thrombosis (ST) is a rare but catastrophic event to happen to a stented coronary artery. The incidence of ST has greatly been reduced after the advent of modern drug-eluting stent (DES) implants, which have become the most preferred treatment option in the stenting category for coronary artery disease (CAD). Although the risk reduction by newer category implant provides substantial benefits, the possibility of thrombosis still exists mostly during the early stage of DES implantation. The development of ST after percutaneous coronary intervention (PCI) can be predicted by multiple factors, but advancements in early diagnostic techniques and modified stent types have greatly reduced the occurrence of this complication. Mortality, which is one of the complications of ST, is primarily influenced by patient-related factors such as incomplete treatment duration of dual antiplatelet therapy (DAPT). The duration of DAPT after DES implantation in patients with acute coronary syndrome (ACS) is determined based on individual characteristics, mainly considered in view of bleeding or ischemia risk. Risk evaluation systems like DAPT/precise-DAPT scores help tailor and personalize the duration of DAPT for each individual patient. This systematic review contains pertinent articles extracted from the PubMed database. We retrieved articles from various study categories, encompassing publications from the period spanning 2014 to 2022. Our analysis highlighted results from studies investigating different aspects contributing to ST development. The most favorable prevention option was the use of customized DAPT intervention based on patientspecific predictable factors. Several complications associated with ST were identified, including recurrent ST, major adverse cardiovascular events (MACE) encompassing all-cause mortality (including cardiac and non-cardiac mortality), cerebrovascular accidents (CVA) or transient ischemic attacks (TIA), hospitalization due to heart failure, and myocardial infarction requiring revascularization. Mortality was also observed as a significant outcome. The umbrella term of ST includes multiple causative factors. Although DES has improved patient survival rates vastly with its usage, careful risk factor assessment and required follow-up, in each individual being stented, further guarantee a more promising reduction in late adverse outcomes.

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

Abstract: Shorter duration (3-6 months) of DAPT, as compared to 12 months, was not associated with a higher risk of death, MI, or stent thrombosis, but a lower rate of major and overall bleeding.

Cited by 9 publications

References 24 publications

Clinical Outcomes of Prolonged Antiplatelet Therapy after Percutaneous Coronary Intervention in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Clinical Outcomes of Prolonged Antiplatelet Therapy after Percutaneous Coronary Intervention in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Dissemination of 2014 dual antiplatelet therapy (DAPT) trial results: a systematic review of scholarly and media attention over 7 months

Identifying the Incidence, Predictors, Outcomes, and Prevention of Stent Thrombosis (ST) in Post-percutaneous Coronary Revascularization Patients With Drug-Eluting Stents (DES): A Systematic Review

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