Three versus 12‐month dual antiplatelet therapy duration in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta‐analysis of randomized controlled trials

Selvaraj, Vijairam; Chatterjee, Saurav; Hirai, Taishi; Abbott, J. Dawn; Bavishi, Chirag

doi:10.1002/ccd.30467

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…In addition, several meta-analyses have been performed against different backgrounds. Moreover, meta-analyses including only ACS patients or older patients were in line with previous findings [ 35 , 36 , 37 ].…”

Section: Discussionsupporting

confidence: 88%

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

Tsigkas

Toutouzas

Chlorogiannis

et al. 2023

Life

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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.

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Section: Discussionsupporting

confidence: 88%

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

Tsigkas

Toutouzas

Chlorogiannis

et al. 2023

Life

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“…Apesar da maior proteção isquêmica assegurada pela estratégia de duração estendida, os regimes de antiagregação prolongada estão diretamente associados à maior indução de eventos hemorrágicos, especialmente nos indivíduos que possuem maior fator de risco para o sangramento maior (Kwok, et al, 2020;Tritschler, et al, 2022;Xu, et al, 2021;Selvaraj, et al, 2022).…”

Section: Tdap Estendida (≥ 12 Meses) Comparada à Tdap De Longa Duraçã...unclassified

Avaliação da duração e do risco de sangramento entre diferentes estratégias de dupla antiagregação plaquetária administradas após a intervenção coronária percutânea: uma revisão de escopo

Santos,

Parreira,

Fracaro

et al. 2023

RSD

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Pacientes portadores Síndrome Coronariana Aguda (SCA) necessitam de implante de stent farmacológico após a intervenção coronária percutânea (ICP), associado à administração de dupla terapia antiplaquetária (TDAP) para a redução do risco trombótico. Considerando a avaliação entre a proteção isquêmica e a chance de eventos hemorrágicos, novas estratégias de TDAP têm sido utilizadas, permitindo-se a prevenção de possíveis desfechos deletérios. O presente estudo objetiva avaliar a duração e o risco de sangramento entre diferentes estratégias de TDAP administradas após a ICP. Para essa revisão de escopo, realizada através das plataformas PubMed e ScienceDirect, entre os anos de 2020 e 2023, os descritores eleitos foram: '’Platelet Aggregation Inhibitors'', ‘’Percutaneous Coronary Intervention’’ e ‘’Hemorrhage’’. Os critérios de inclusão consistiram em (1) avaliação da duração e do risco de sangramento em distintas estratégias de TDAP (2) análise entre diferentes tipos de antiagregantes plaquetários (3) estudos que abordaram o seguimento e o manejo clínico (4) artigos em inglês e português. Os critérios de exclusão consistiram em inadequações ao tema, relatos de casos, editoriais, revisões simples, estudos com animais, além de textos fora do limite temporal. Regimes de TDAP prolongada e de longa duração apresentaram maior proteção isquêmica e maior risco de sangramento. Regimes de curta ou curtíssima duração estiveram associados à redução das taxas de sangramento maior, sendo benéficos aos pacientes idosos ou trombocitopênicos. O manejo de casos com alto risco trombótico e hemorrágico, assim como a utilização de escores preditivos permanecem como tópicos controversos a serem elucidados através de novos estudos.

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“…Исследование ISIS-2 в 1988 г. показало, что комбинированная терапия аспирином и стрептокиназой в условиях ИМ имела колоссальные результаты в снижении смертности. В дальнейшем использование двойной антитромбоцитарной терапии с применением клопидогрела, тикагрелора и празугрела продемонстрировало дополнительные возможности в уменьшении летальности при ИМ [23][24][25].…”

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Modern ways to reduced mortality of myocardial infarction. What should be done?

Barbarash,

Pecherina

2023

Sibirskij nauchnyj medicinskij zhurnal

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Myocardial infarction is a formidable manifestation of coronary artery disease and accounts for one third of deaths associated with coronary disease. In Russia, from 400 to 500 thousand patients with acute coronary syndrome are hospitalized annually, about half of them with myocardial infarction (MI). The dynamics of the number of hospitalized patients in recent years indicates its reduction. Short-term mortality (30-day, including hospital mortality) after acute MI has decreased significantly over the past 50 years: in absolute terms from 30 % in 1950 to 5–8 % at present. However, long-term mortality after MI did not improve. Moreover, in recent years, the rate of decline in 30-day mortality from MI has decreased significantly, almost reaching a “plateau” over the past 15 years. It has been established that in terms of the impact on survival, disability and quality of life of the working population, MI is an important not only medical but also social problem. This review of the literature discusses changes in approaches to reducing mortality in MI, as well as the main events in evidence-based cardiology over the past 50 years, which have made it possible to effectively manage the risk of death in this category of patients.

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Three versus 12‐month dual antiplatelet therapy duration in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta‐analysis of randomized controlled trials

Cited by 4 publications

References 33 publications

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

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

Avaliação da duração e do risco de sangramento entre diferentes estratégias de dupla antiagregação plaquetária administradas após a intervenção coronária percutânea: uma revisão de escopo

Modern ways to reduced mortality of myocardial infarction. What should be done?

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