title: Safety of short-term dual antiplatelet therapy after drug-eluting stents: An updated meta-analysis with direct and adjusted indirect comparison of randomized control trials.
abstract: BACKGROUND
  Duration of dual antiplatelet therapy (DAPT) following drug-eluting stents (DES) remains controversial and is a topic of ongoing research.
  
  
  METHODS
  Direct and adjusted indirect comparisons of all the recent randomized control trials (RCTs) were performed to evaluate the safety of short-term versus long-term DAPT following DES.
  
  
  RESULTS
  8 RCTs were identified and 7 (16,318 subjects) were included. 4 groups of 3 vs 12 months, 6 vs 12 months, 6 vs 24 months and 12 vs 24 months of DAPT were used for direct comparison. There was no significant difference in stent thrombosis, myocardial infarction (MI), stroke and revascularization, cardiovascular and all-cause mortality between the different durations in all 4 groups. Pooling trials of 3-6 months of DAPT against 12 months, we found a significant reduction in the risk of total bleeding (RR 0.61, 95% CI 0.43-0.87). Adjusted indirect comparison between 3 vs 6 months, 3 vs 24 months and 6 vs 24 month duration of DAPT showed no significant differences in risk of death or MI, or revascularization between 3 or 6 months and 24 months. However, 24months of DAPT was associated with significantly more bleeding than 3 or 6 months.
  
  
  CONCLUSIONS
  3 to 6 months of DAPT following second generation DES and above is safe with no increased risk of thrombotic complications and mortality, and lower bleeding risk. However a tailored approach may be more appropriate for high-risk patients.
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK. Electronic address: h.bulluck@gmail.com.
authors.forename: Heerajnarain
authors.initials: H
authors.lastname: Bulluck
authors.affiliation: Institute of Cardiovascular Sciences, University of Manchester, Manchester Royal Infirmary, Manchester M13 9WL, UK. Electronic address: shingkwok@doctors.org.uk.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK. Electronic address: alisdair.ryding@nnuh.nhs.uk.
authors.forename: Alisdair D
authors.initials: AD
authors.lastname: Ryding
authors.affiliation: 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. Electronic address: y.loke@uea.ac.uk.
authors.forename: Yoon K
authors.initials: YK
authors.lastname: Loke
mesh_terms: D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000639:trends*; D006470:Hemorrhage / Q000139:chemically induced / Q000175:diagnosis; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000639:trends; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D013927:Thrombosis / Q000139:chemically induced / Q000175:diagnosis; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Acute coronary syndrome; Drug-eluting stent; Dual antiplatelet treatment; Duration of therapy; Percutaneous coronary intervention