Dual antiplatelet therapy duration after percutaneous coronary intervention using drug eluting stents in high bleeding risk patients: A systematic review and meta-analysis - 11/06/22
, Amit Rout, MD b, Serdar Farhan, MD c, Sergio Waxman, MD d, Gennaro Giustino, MD b, Raj Tayal, MD e, Jinette Dawn Abbott, MD a, Kurt Huber, MD f, Dominick J. Angiolillo, MD, PhD g, Sunil V. Rao, MD hAbstract |
Background |
Optimal dual antiplatelet therapy (DAPT) duration in patients at high bleeding risk (HBR) is not fully defined. We aimed to compare the safety and effectiveness of short-term DAPT (S-DAPT) with longer duration DAPT (L-DAPT) after percutaneous coronary intervention (PCI) with drug eluting stents (DES) in patients at HBR.
Methods |
We searched for studies comparing S-DAPT (≤3 months) followed by aspirin or P2Y 12 inhibitor monotherapy against L-DAPT (6-12 months) after PCI in HBR patients. Primary end points of interest were major bleeding and myocardial infarction (MI). Random-effects meta-analyses were performed to calculate odds ratios with 95% CIs.
Results |
Six randomized trials and 3 propensity-matched studies (n = 16,848) were included in the primary analysis. Compared with L-DAPT (n = 8,422), major bleeding was lower with S-DAPT (n = 8,426) [OR 0.68; 95% CI 0.51-0.89] whereas MI did not differ significantly between the 2 groups [1.16; 0.94-1.44]. There were no significant differences in risks of death, stroke or stent thrombosis (ST) between S-DAPT and L-DAPT groups. These findings were consistent when propensity-matched studies were analysed separately. Finally, there was a numerically higher, albeit statistically non-significant, ST in the S-DAPT arm of patients without an indication for OAC [1.98; 0.86-4.58].
Conclusions |
Among HBR patients undergoing current generation DES implantation, S-DAPT reduces bleeding without an increased risk of death or MI compared with L-DAPT. More research is needed to (1) evaluate risks of late ST after 1 to 3 months DAPT among patients with high ischemic and bleeding risks, (2) defining the SAPT of choice after 1 to 3 months DAPT.
Le texte complet de cet article est disponible en PDF.Abbreviations : ACS, ASA, CI, CV, DAPT, DES, HBR, L-DAPT, MACCE, MI, PCI, RCT, S-DAPT, ST
Plan
| Condensed abstract |
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| We aimed to compare short-term dual antiplatelet therapy (S-DAPT) with longer duration DAPT (L-DAPT) after drug eluting stents (DES) implantation in patients at high bleeding risk (HBR). Compared with L-DAPT, the odds of major bleeding were lower with S-DAPT [OR 0.63; 95% CI 0.44-0.90] whereas MI did not differ significantly between the 2 groups [1.31; 0.96-1.80]. There were no significant differences in risks of all-cause death, CV death or MI between S-DAPT and L-DAPT. In conclusion, among HBR patients undergoing current generation DES implantation, S-DAPT reduces bleeding without an increased risk of death or MI compared with L-DAPT. |
Vol 250
P. 1-10 - août 2022 Retour au numéro
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