title: Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  To assess the benefits and risks of short term (<12 months) or extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12 month therapy, following percutaneous coronary intervention with drug eluting stents.
  
  
  METHODS
  Meta-analysis of randomised controlled trials.
  
  
  METHODS
  PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library, and major congress proceedings, searched from 1 January 2002 to 16 February 2015.
  
  
  METHODS
  Trials comparing short term (<12 months) or extended (>12 months) DAPT regimens with standard 12 month duration of therapy. Primary outcomes were cardiovascular mortality, myocardial infarction, stent thrombosis, major bleeding, and all cause mortality.
  
  
  RESULTS
  10 randomised controlled trials (n=32,287) were included. Compared to 12 month DAPT, a short term course of therapy was associated with a significant reduction in major bleeding (odds ratio 0.58 (95% confidence interval 0.36 to 0.92); P=0.02) with no significant differences in ischaemic or thrombotic outcomes. Extended versus 12 month DAPT yielded a significant reduction in the odds of myocardial infarction (0.53 (0.42 to 0.66); P<0.001) and stent thrombosis (0.33 (0.21 to 0.51); P<0.001), but more major bleeding (1.62 (1.26 to 2.09); P<0.001). All cause but not cardiovascular death was also significantly increased (1.30 (1.02 to 1.66); P=0.03).
  
  
  CONCLUSIONS
  Compared with a standard 12 month duration, short term DAPT (<12 months) after drug eluting stent implementation yields reduced bleeding with no apparent increase in ischaemic complications, and could be considered for most patients. In selected patients with low bleeding risk and very high ischaemic risk, extended DAPT (>12 months) could be considered. The increase in all cause but not cardiovascular death with extended DAPT requires further investigation.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany eliano.navarese@alice.it.
authors.forename: Eliano Pio
authors.initials: EP
authors.lastname: Navarese
authors.affiliation: Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany Department of Cardiovascular Science, Catholic University, Rome, Italy.
authors.forename: Felicita
authors.initials: F
authors.lastname: Andreotti
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Schulze
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland.
authors.forename: Michalina
authors.initials: M
authors.lastname: Kołodziejczak
authors.affiliation: Department of Cardiovascular Science, Catholic University, Rome, Italy Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany.
authors.forename: Antonino
authors.initials: A
authors.lastname: Buffon
authors.affiliation: Department of Cardiology, University Medical Centre St Radboud, Nijmegen, Netherlands Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Brouwer
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Francesco
authors.initials: F
authors.lastname: Costa
authors.affiliation: Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany Department of Cardiology, 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kowalewski
authors.affiliation: Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, University of Milan-Bicocca, Milan, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.affiliation: Department of Cardiology, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
mesh_terms: D001241:Aspirin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000628:therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin