Short-term vs long-term dual antiplatelet therapy after drug-eluting stent implantation in patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis
Jingxin Li
Department of Chinese pharmacy, Hebei Maternity Hospital, Shijiazhuang, Hebei Province, China
Search for more papers by this authorCorresponding Author
Ke He
Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
Correspondence
Ke He, Department of Pharmacy, The Fourth Hospital of Shijiazhuang, 206 Zhongshan East Road, Changan District, Shijiazhuang 050017, Hebei Province, China.
Email: [email protected]
Search for more papers by this authorJun Ge
Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
Search for more papers by this authorCaixia Li
Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
Search for more papers by this authorZeng Jing
Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
Search for more papers by this authorJingxin Li
Department of Chinese pharmacy, Hebei Maternity Hospital, Shijiazhuang, Hebei Province, China
Search for more papers by this authorCorresponding Author
Ke He
Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
Correspondence
Ke He, Department of Pharmacy, The Fourth Hospital of Shijiazhuang, 206 Zhongshan East Road, Changan District, Shijiazhuang 050017, Hebei Province, China.
Email: [email protected]
Search for more papers by this authorJun Ge
Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
Search for more papers by this authorCaixia Li
Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
Search for more papers by this authorZeng Jing
Department of Pharmacy, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
Search for more papers by this authorAbstract
Objective
The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is under controversial. The aim of the present systematic review and meta-analysis was to evaluate the safety and efficacy of short-term (≤6 months) DAPT vs long-term (≥12 months) DAPT after PCI with a drug-eluting stent (DES).
Methods
We systematically searched the Cochrane Library, PubMed and Embase databases to identify randomised controlled trials (RCTs) that compared short-term (≤6 months) and long-term (≥12 months) DAPT. The endpoints included major bleeding, any bleeding, death from any cause, cardiac death, myocardial infarction, stroke, stent thrombosis and target vessel revascularisation. The primary outcome was major bleeding. A fixed-effects model was used to calculate the risk ratio (RR) and 95% confidence interval (CI) of each endpoint.
Results
Eighteen trials involving 57,940 patients were included. Compared with long-term DAPT, short-term DAPT resulted in lower rates of major bleeding [RR 0.75, 95% CI 0.65-0.87, P = .0002] and any bleeding [RR 0.61, 95% CI 0.54-0.69, P < .00001]. No significant difference was observed in the outcomes of death from any cause, cardiac death, myocardial infarction, stroke, stent thrombosis, or target vessel revascularisation. The subgroup analysis according to different DAPT durations, mono antiplatelet therapies (MAPTs), countries and P2Y12 inhibitors produced similar outcomes as comprehensive outcomes.
Conclusions
Compared with long-term DAPT, short-term DAPT did not increase the risk of ischemic complications but did reduce the risks of major bleeding and any bleeding by over 25%. This study showed that short-term DAPT could be considered for most patients after DES implantation.
DISCLOSURE
The authors have declared no conflicts of interest for this article.
Supporting Information
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| ijcp13938-sup-0001-FigS1-S8-TableS1-S2.docWord document, 338.5 KB | Fig S1-S8-Table S1-S2 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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