Benefits and harms of extending the duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stents: a meta-analysis.
BACKGROUND
The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is unclear.


METHODS
We conducted a systematic review and meta-analysis of randomized controlled trials evaluating risk of adverse events in participants receiving different durations of DAPT following insertion of drug-eluting stents.


RESULTS
Five trials were included, but only four had data suitable for meta-analysis (n = 8,231 participants). No significant increase in the composite endpoint of death and nonfatal myocardial infarction was observed with earlier cessation of DAPT in any instance when compared to longer durations of DAPT (RR 0.64 95% CI 0.25-1.63 for 3 versus 12 months, RR 1.09 95% CI 0.84-1.41 for 6 versus 12 months and, RR 0.64 95% CI 0.35-1.16 for 12 versus 24 months). Pooled results showed a significantly lower risk of major bleeding (RR 0.48 95% CI 0.25-0.93) and total bleeding (RR 0.30 95% CI 0.16-0.54) for shorter compared to longer duration of DAPT. Subgroup analysis based on age, prior diabetes, and prior ACS failed to show any group where longer durations were consistently better than shorter ones.


CONCLUSIONS
There are no cardiovascular or mortality benefits associated with extended duration of DAPT, but the risk of major bleeding was significantly lower with shorter lengths of therapy.
Institute of Cardiovascular Sciences, University of Manchester, Manchester Royal Infirmary, Manchester M13 9WL, UK.
Chun Shing
0000-0001-7047-1586
CS
Kwok
Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
Heerajnarain
0000-0002-1985-1783
H
Bulluck
Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
Alisdair D
AD
Ryding
Institute of Cardiovascular Sciences, University of Manchester, Manchester Royal Infirmary, Manchester M13 9WL, UK ; Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK ; Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
Yoon K
YK
Loke
D002986:Clinical Trials as Topic; D054855:Drug-Eluting Stents; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016896:Treatment Outcome