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open access

Vol 30, No 4 (2023)
Original Article
Submitted: 2022-01-26
Accepted: 2022-07-08
Published online: 2022-07-29
View PDF Download PDF file View HTML Supp./Additional Files [1]
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Dual antiplatelet therapy after percutaneous coronary intervention in patients at high bleeding risk: A systematic review and meta-analysis

Yan Han1, Xiaohang Yuan1, Xin Hu1, Yan Fang1, Mengting Jiang1, Huanhuan Feng2, Lei Gao1
DOI: 10.5603/CJ.a2022.0071
·
Pubmed: 35912712
·
Cardiol J 2023;30(4):556-566.
Affiliations
  1. Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
  2. Department of Emergency, First Medical Center of Chinese PLA General Hospital, Beijing, China

open access

Vol 30, No 4 (2023)
Original articles — Clinical cardiology
Submitted: 2022-01-26
Accepted: 2022-07-08
Published online: 2022-07-29

Abstract

Background: To date, it has not been ascertained whether shortening the duration of dual antiplatelet
therapy (DAPT) can benefit high bleeding risk (HBR) patients. This systematic review and meta-analysis
was performed to investigate the safety and efficacy of short (≤ 3 months) DAPT in HBR patients
after percutaneous coronary intervention (PCI).

Methods: The PubMed, Embase, and Clinical Trials databases were searched from inception until
November 2021 to identify studies that evaluated the safety and efficacy of short DAPT in HBR patients
implanted with new-generation drug-eluting stents (DES). Primary endpoints included major bleeding,
definite or probable stent thrombosis (ST), and myocardial infarction (MI), while secondary endpoints
included all-cause death and ischemic stroke. Based on the fixed and random effect model, the risk ratio
(RR) and 95% confidence interval of each endpoint were measured.

Results: Five observational studies and one randomized controlled trial were included, involving
15,432 HBR patients. Short DAPT for HBR patients undergoing PCI had a lower incidence of major
bleeding in comparison with standard (> 3 months) DAPT (2.3% vs. 3.2%, RR 0.64 [0.44, 0.95],
p = 0.03), while short DAPT was comparable to standard DAPT with regard to definite or probable ST
(0.4% vs. 0.3%, RR 1.31 [0.77, 2.23], p = 0.32) and MI (2.4% vs. 2.0%, RR 1.17 [0.95, 1.45], p = 0.14).

Conclusions: Among HBR patients implanted with new-generation DES, short DAPT was associated
with reduced risk of major bleeding without significantly increasing the risk of definite or probable ST
and MI in comparison with standard DAPT.

Abstract

Background: To date, it has not been ascertained whether shortening the duration of dual antiplatelet
therapy (DAPT) can benefit high bleeding risk (HBR) patients. This systematic review and meta-analysis
was performed to investigate the safety and efficacy of short (≤ 3 months) DAPT in HBR patients
after percutaneous coronary intervention (PCI).

Methods: The PubMed, Embase, and Clinical Trials databases were searched from inception until
November 2021 to identify studies that evaluated the safety and efficacy of short DAPT in HBR patients
implanted with new-generation drug-eluting stents (DES). Primary endpoints included major bleeding,
definite or probable stent thrombosis (ST), and myocardial infarction (MI), while secondary endpoints
included all-cause death and ischemic stroke. Based on the fixed and random effect model, the risk ratio
(RR) and 95% confidence interval of each endpoint were measured.

Results: Five observational studies and one randomized controlled trial were included, involving
15,432 HBR patients. Short DAPT for HBR patients undergoing PCI had a lower incidence of major
bleeding in comparison with standard (> 3 months) DAPT (2.3% vs. 3.2%, RR 0.64 [0.44, 0.95],
p = 0.03), while short DAPT was comparable to standard DAPT with regard to definite or probable ST
(0.4% vs. 0.3%, RR 1.31 [0.77, 2.23], p = 0.32) and MI (2.4% vs. 2.0%, RR 1.17 [0.95, 1.45], p = 0.14).

Conclusions: Among HBR patients implanted with new-generation DES, short DAPT was associated
with reduced risk of major bleeding without significantly increasing the risk of definite or probable ST
and MI in comparison with standard DAPT.

Full Text:

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Keywords

duration, dual antiplatelet therapy, new-generation stent, high bleeding risk, percutaneous coronary intervention

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About this article
Title

Dual antiplatelet therapy after percutaneous coronary intervention in patients at high bleeding risk: A systematic review and meta-analysis

Journal

Cardiology Journal

Issue

Vol 30, No 4 (2023)

Article type

Original Article

Pages

556-566

Published online

2022-07-29

Page views

1030

Article views/downloads

446

DOI

10.5603/CJ.a2022.0071

Pubmed

35912712

Bibliographic record

Cardiol J 2023;30(4):556-566.

Keywords

duration
dual antiplatelet therapy
new-generation stent
high bleeding risk
percutaneous coronary intervention

Authors

Yan Han
Xiaohang Yuan
Xin Hu
Yan Fang
Mengting Jiang
Huanhuan Feng
Lei Gao

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