open access

Vol 23, No 3 (2016)
INTERVENTIONS Original articles
Published online: 2015-12-04
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The optimal duration of dual antiplatelet therapy in patients receiving percutaneous coronary intervention with drug-eluting stents

Olusegun Sheyin, Xavier Perez, Bredy Pierre-Louis, Damian Kurian
DOI: 10.5603/CJ.a2015.0078
·
Pubmed: 26711462
·
Cardiol J 2016;23(3):307-316.

open access

Vol 23, No 3 (2016)
INTERVENTIONS Original articles
Published online: 2015-12-04

Abstract

Background: The optimal duration of dual antiplatelet therapy (DAPT) following drugeluting stent (DES) implantation remains a subject of an ongoing debate.

Methods: MEDLINE, EMBASE, Scopus and CENTRAL databases were searched for eligible randomized controlled trials (RCTs) that compared short-term (£ 6 months) DAPT with long-term (≥ 12 months) DAPT following DES implantation. The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), stroke, or major bleeding. The secondary outcome were the individual components of the primary outcome, cardiovascular death, stent thrombosis and any bleeding episode.

Results: A total of 15,378 patients from 7 RCTs were studied. There were no statistically significant differences between the short-term and long-term DAPT groups with respect to the occurrence of the primary outcome (risk ratio [RR] 1.017; 0.872–1.186; I2 = 0%), all cause death (RR 0.896; 0.708–1.134), cardiovascular death (RR 0.924; 0.668–1.279), MI (RR 1.139; 0.887–1.461), TVR (RR 1.174; 0.916–1.505), stent thrombosis (RR 1.264; 0.786–2.032), and stroke (RR 0.876; 0.685–1.611). However, there was a statistically significant lower risk of major bleeding in the short-term DAPT group (RR 0.57; 0.36–0.90; p = 0.02). There were no statistically significant differences in the sub-group analysis of patients with diabetes and patients presenting with acute coronary syndrome, RR 1.029; 0.745–1.421 and RR 1.062; 0.785–1.438, respectively.

Conclusions: There was no difference in efficacy outcomes between short-term and long-term DAPT following DES, even among high-risk patients. However, longer duration of DAPT was found to be associated with increased risk of major bleeding.  

Abstract

Background: The optimal duration of dual antiplatelet therapy (DAPT) following drugeluting stent (DES) implantation remains a subject of an ongoing debate.

Methods: MEDLINE, EMBASE, Scopus and CENTRAL databases were searched for eligible randomized controlled trials (RCTs) that compared short-term (£ 6 months) DAPT with long-term (≥ 12 months) DAPT following DES implantation. The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), stroke, or major bleeding. The secondary outcome were the individual components of the primary outcome, cardiovascular death, stent thrombosis and any bleeding episode.

Results: A total of 15,378 patients from 7 RCTs were studied. There were no statistically significant differences between the short-term and long-term DAPT groups with respect to the occurrence of the primary outcome (risk ratio [RR] 1.017; 0.872–1.186; I2 = 0%), all cause death (RR 0.896; 0.708–1.134), cardiovascular death (RR 0.924; 0.668–1.279), MI (RR 1.139; 0.887–1.461), TVR (RR 1.174; 0.916–1.505), stent thrombosis (RR 1.264; 0.786–2.032), and stroke (RR 0.876; 0.685–1.611). However, there was a statistically significant lower risk of major bleeding in the short-term DAPT group (RR 0.57; 0.36–0.90; p = 0.02). There were no statistically significant differences in the sub-group analysis of patients with diabetes and patients presenting with acute coronary syndrome, RR 1.029; 0.745–1.421 and RR 1.062; 0.785–1.438, respectively.

Conclusions: There was no difference in efficacy outcomes between short-term and long-term DAPT following DES, even among high-risk patients. However, longer duration of DAPT was found to be associated with increased risk of major bleeding.  

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Keywords

dual antiplatelet therapy, drug-eluting stent, bleeding, stent thrombosis

About this article
Title

The optimal duration of dual antiplatelet therapy in patients receiving percutaneous coronary intervention with drug-eluting stents

Journal

Cardiology Journal

Issue

Vol 23, No 3 (2016)

Pages

307-316

Published online

2015-12-04

DOI

10.5603/CJ.a2015.0078

Pubmed

26711462

Bibliographic record

Cardiol J 2016;23(3):307-316.

Keywords

dual antiplatelet therapy
drug-eluting stent
bleeding
stent thrombosis

Authors

Olusegun Sheyin
Xavier Perez
Bredy Pierre-Louis
Damian Kurian

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