Thirty-Days versus Longer Duration of Dual Antiplatelet Treatment after Percutaneous Coronary Interventions with Newer Drug-Eluting Stents: A Systematic Review and Meta-Analysis

Abstract

Abbreviation of the duration of dual antiplatelet therapy (DAPT) (one or three months) has been recently proposed, especially for high bleeding risk patients, after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Three databases were screened for eligible randomized control trials. The primary endpoint was the incidence of net adverse clinical events (NACE). Secondary endpoints consisted of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infarction, stroke, stent-thrombosis, repeat revascularization and major bleeding. We included four RCTs with a total of 26,576 patients; 13,282 patients were grouped in 30-days DAPT, while the remaining 13,294 were allocated in a longer period of DAPT. One month of DAPT did not significantly reduce NACE (odds ratio [OR]: 0.87, 95% confidence intervals [Cl]: 0.74–1.03); however, major bleedings were significantly reduced by 22% (OR: 0.78, 95% Cl: 0.65–0.94). Mortality or ischemic events (stroke, myocardial infarction, revascularization and stent thrombosis) were not affected. Thus, 30-days DAPT could be considered as safe and feasible after PCI with DES in selected patients, especially those with high bleeding risk. Forthcoming RCTs could shed light on the optimal duration of DAPT.

Efficacy and Safety of Thirty-Day Dual-Antiplatelet Therapy Following Complex Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

“…The clinical advantages of DAPT duration shortening have been substantiated in meta-analyses encompassing both individuals at high and low risk of bleeding events. As previously shown, one-month DAPT reduces major bleedings by 22% (OR: 0.78, 95% Cl: 0.65-0.94) and one or three months of DAPT by 29% (OR 0.71, 95% Cl 0.61-0.82), without having a negative impact on mortality, composite outcomes, or ischemic events, respectively [8,20,53,54]. Nonetheless, the benefits are more pronounced in high-risk bleeding patients, as evidenced by the results of two recent meta-analyses.…”

Duration of Dual Antiplatelet Treatment After Percutaneous Coronary Intervention in Patients With Diabetes: A Systematic Review and Meta-analysis

“…[1][2][3] Emerging evidence from recent randomizedcontrolled trials and meta-analyses indicates that shorter DAPT (S-DAPT) regimens (1 or 3 months) may be a safer and more effective alternative to standard durations of DAPT, even in high-ischemic risk patients undergoing complex PCI or those with ACSs. [4][5][6][7][8] Diabetes is another factor that increases thrombotic risk, and the use of S-DAPT regimens in diabetic patients has been a subject of controversy in cardiology. The objective of our systematic review and metaanalysis is to evaluate the safety and efficacy of S-DAPT regimens in diabetic patients.…”

Terapia antiagregante plaquetária em pacientes com síndrome coronariana aguda submetidos a intervenção percutânea: uma revisão bibliográfica

“…Com o envelhecimento da população mundial e aumento nos níveis de sedentarismo, a síndrome coronariana aguda (SCA) representa uma das principais causas de morbidade e mortalidade em todo o mundo, caracterizando-se por um espectro de condições que incluem infarto agudo do miocárdio (IAM) com supradesnivelamento do segmento ST (IAM com supra), IAM sem supra e angina instável (KHAN, et al, 2020). O tratamento da SCA, particularmente em pacientes submetidos à intervenção coronariana percutânea (ICP), é uma Brazilian Journal of Health Review, Curitiba, v. 7, n. 3, p. 01-15, may/jun., 2024 questão complexa, com foco na prevenção de eventos trombóticos recorrentes (TSIGKAS, et al, 2023). A história da intervenção percutânea remonta a meados do século XX, com os primeiros relatos de angioplastia coronária transluminal percutânea (PTCA) que começou a ser realizada na década de 70.…”