title: The optimal duration of dual antiplatelet therapy in patients receiving percutaneous coronary intervention with drug-eluting stents.
abstract: BACKGROUND
  The optimal duration of dual antiplatelet therapy (DAPT) following drugeluting stent (DES) implantation remains a subject of an ongoing debate.
  
  
  METHODS
  MEDLINE, EMBASE, Scopus and CENTRAL databases were searched for eligible randomized controlled trials (RCTs) that compared short-term (￡ 6 months) DAPT with long-term (≥ 12 months) DAPT following DES implantation. The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), stroke, or major bleeding. The secondary outcome were the individual components of the primary outcome, cardiovascular death, stent thrombosis and any bleeding episode.
  
  
  RESULTS
  A total of 15,378 patients from 7 RCTs were studied. There were no statistically significant differences between the short-term and long-term DAPT groups with respect to the occurrence of the primary outcome (risk ratio [RR] 1.017; 0.872-1.186; I2 = 0%), all cause death (RR 0.896; 0.708-1.134), cardiovascular death (RR 0.924; 0.668-1.279), MI (RR 1.139; 0.887-1.461), TVR (RR 1.174; 0.916-1.505), stent thrombosis (RR 1.264; 0.786-2.032), and stroke (RR 0.876; 0.685-1.611). However, there was a statistically significant lower risk of major bleeding in the short-term DAPT group (RR 0.57; 0.36-0.90; p = 0.02). There were no statistically significant differences in the sub-group analysis of patients with diabetes and patients presenting with acute coronary syndrome, RR 1.029; 0.745-1.421 and RR 1.062; 0.785-1.438, respectively.
  
  
  CONCLUSIONS
  There was no difference in efficacy outcomes between short-term and long-term DAPT following DES, even among high-risk patients. However, longer duration of DAPT was found to be associated with increased risk of major bleeding.
authors.affiliation: Department of Medicine, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York, United States. olusegun.sheyin@nychhc.org.
authors.forename: Olusegun
authors.initials: O
authors.lastname: Sheyin
authors.forename: Xavier
authors.initials: X
authors.lastname: Perez
authors.forename: Bredy
authors.initials: B
authors.lastname: Pierre-Louis
authors.forename: Damian
authors.initials: D
authors.lastname: Kurian
mesh_terms: D054855:Drug-Eluting Stents; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: bleeding; drug-eluting stent; dual antiplatelet therapy; stent thrombosis