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


- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Emergency, First Medical Center of Chinese PLA General Hospital, Beijing, China
open access
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.
Keywords
duration, dual antiplatelet therapy, new-generation stent, high bleeding risk, percutaneous coronary intervention




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