title: Longer- Versus Shorter-Duration Dual-Antiplatelet Therapy After Drug-Eluting Stent Placement: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  The appropriate duration of dual-antiplatelet therapy (DAPT) after drug-eluting stent (DES) placement remains controversial.
  
  
  OBJECTIVE
  To summarize data on clinical outcomes with longer- versus shorter-duration DAPT after DES placement in adults with coronary artery disease.
  
  
  METHODS
  Ovid MEDLINE and EMBASE, 1996 to 27 March 2015, and manual screening of references.
  
  
  METHODS
  Randomized, controlled trials comparing longer- versus shorter-duration DAPT after DES placement.
  
  
  METHODS
  Two reviewers screened potentially eligible articles; extracted data on populations, interventions, and outcomes; assessed risk of bias; and used the Grading of Recommendations Assessment, Development and Evaluation guidelines to rate overall confidence in effect estimates.
  
  
  RESULTS
  Among 1010 articles identified, 9 trials including 29,531 patients were eligible; data were complete for 28,808 patients. Moderate-quality evidence showed that longer-duration DAPT decreased risk for myocardial infarction (risk ratio [RR], 0.73 [95% CI, 0.58 to 0.92]) and increased mortality (RR, 1.19 [CI, 1.04 to 1.36]). High-quality evidence showed that DAPT increased risk for major bleeding (RR, 1.63 [CI, 1.34 to 1.99]).
  
  
  CONCLUSIONS
  Confidence in estimates were decreased owing to imprecision for most outcomes (particularly myocardial infarction), risk of bias from limited blinding in 7 of 9 studies, indirectness due to variability in use of first- and second-generation stents, and off-protocol use of DAPT in some studies.
  
  
  CONCLUSIONS
  Extended DAPT is associated with approximately 8 fewer myocardial infarctions per 1000 treated patients per year but 6 more major bleeding events than shorter-duration DAPT. Because absolute effects are very small and closely balanced, decisions regarding the duration of DAPT therapy must take into account patients' values and preference.
  
  
  BACKGROUND
  None.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Manya
authors.initials: M
authors.lastname: Prasad
authors.forename: Per O
authors.initials: PO
authors.lastname: Vandvik
authors.forename: Devin
authors.initials: D
authors.lastname: Chetan
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhou
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
mesh_terms: D002423:Cause of Death; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012086:Reoperation; D018570:Risk Assessment
chemical_list: D010975:Platelet Aggregation Inhibitors