Duration of dual antiplatelet therapy after drug-eluting stent implantation: Meta-analysis of large randomised controlled trials.
Patients receive dual antiplatelet therapy (DAPT) for 6-12 months after drug-eluting stents (DES) implantation. The efficacy and safety of prolonged DAPT has been questioned. Therefore, we performed a meta-analysis on randomised trials comparing different DAPT durations. Literature was searched on trials comparing different DAPT durations. For inclusion, reports must report frequency of cardiovascular and bleeding events. Ten trials were included. Compared to 12 months, DAPT beyond 12 months was associated with fewer myocardial infarctions (OR 0.58 95%CI: 0.40-0.84) and stent thrombosis (OR 0.35 95%CI: 0.20-0.62), but more major bleeds (OR 1.60 95%CI: 1.22-2.11) and all-cause (OR 1.30 95%CI: 1.02-1.66) mortality. There was no significant alteration in risk of stroke (OR 0.93 95%CI: 0.66-1.31) or cardiac (OR 1.12 95%CI: 0.73-1.71) mortality. Compared to less than 12 months DAPT, 12 months DAPT did not reduce risk of myocardial infarction, stent thrombosis, strokes, cardiac or all-cause mortality, but increased the risk of major bleeds (OR 1.60 95%CI: 1.22-2.11). DAPT beyond 12 months reduce risk of myocardial infarction and stent thrombosis, but there is substantial increase in major bleeding risk and all-cause mortality which need to be addressed. DAPT beyond 12 months does not appear to alter the risk of stroke.
Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
Man-Fung
MF
Tsoi
1] Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China [2] Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong, China [3] Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong, China [4] Partner State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China [5] Centre for Genomic Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China.
Ching-Lung
CL
Cheung
1] Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China [2] Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong, China.
Tommy Tsang
TT
Cheung
1] Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong, China [2] Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong, China [3] Partner State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China.
Ian Chi-Kei
IC
Wong
1] Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China [2] Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
Cyrus Rustam
CR
Kumana
1] Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong, China [2] Division of Cardiology, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China [3] Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
Hung-Fat
HF
Tse
1] Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China [2] Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong, China [3] Partner State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China [4] Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
Bernard Man-Yung
BM
Cheung
D001241:Aspirin / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D016208:Databases, Factual; D054855:Drug-Eluting Stents / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019736:Prostheses and Implants; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D012306:Risk; D013927:Thrombosis / Q000188:drug therapy*
D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin