Thirty-days versus standard duration of dual antiplatelet treatment after percutaneous coronary interventions: a systematic review and meta-analysis

Abstract

Background/Introduction Abbreviation of 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). Purpose The purpose of the specific systematic review and meta-analysis was to compare 30-days versus longer duration (≥3 months) of DAPT in patients undergoing PCI with DES, focusing on ischemic and bleeding events. Methods Three databases were screened for eligible randomized-control trials. The primary endpoint was the incidence of net adverse clinical events (NACE), as they were defined in each trial. Secondary endpoints consisted of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infraction, stroke, stent-thrombosis, repeat revascularization and major bleeding. Results We included 4 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 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 infraction, revascularization and stent thrombosis) were not affected. Conclusions Thirty-days DAPT did not significantly affect NACEs. However, odds of major bleedings were reduced significantly by 22%. Mortality and ischemic events did not differ between the two arms. Thus, 30-days DAPT could be considered as a safe and feasible after PCI with DES in selected patients, especially those in high-bleeding risk. Forthcoming RCTs could shed light on the optimal duration of DAPT. Funding Acknowledgement Type of funding sources: None.

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

“…Taking that into consideration, numerous RCTs have investigated whether one-month DAPT was safe and feasible. Our meta-analysis confirms the safety and efficacy of shortening DAPT duration to one month [ 34 ]. According to our findings, one-month DAPT significantly reduces major bleedings by 21%, without exposing patients to higher ischemic or mortality risk during one-year follow-up.…”

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

“…Subsequently, 21 reports underwent full-text screening. Through consideration of the reference lists of these studies, a total of three studies were considered eligible and included in this systematic review and meta-analysis [20][21][22]. Our systematic search of the literature is depicted in the PRISMA flowchart (Supplementary Figure S1).…”

Very Short Versus Longer Dual Antiplatelet Treatment After Coronary Interventions: A Systematic Review and Meta-analysis

“…Our findings are in accordance with the current European Society of Cardiology guidelines that support the very short duration of DAPT for both ACS and CCS patients under special circumstances [ 4 , 30 ]. Taking into consideration the fact that many of the analyzed studies included ACS patients, 1- or 3-month DAPT duration could be a feasible option for acute patients with high bleeding risk [ 31 ].…”