title: The Tradeoff Between Shorter and Longer Courses of Dual Antiplatelet Therapy After Implantation of Newer Generation Drug-Eluting Stents.
abstract: The benefit of prolonged dual antiplatelet therapy (DAPT) after implantation of drug-eluting stents (DESs) remains uncertain. In 10 randomized controlled trials (RCTs) of 31,666 predominantly low-risk patients undergoing DES implantation, shorter courses (3-12 months) of DAPT resulted in lower mortality (odds ratio [OR] 0.83, 95 % confidence interval [CI] 0.69-0.98) and major hemorrhage (OR 0.60, 95 % CI 0.48-0.75) but increased myocardial infarction (MI, OR 1.34, 95 % CI 1.04-1.73) and stent thrombosis (ST, OR 1.75, 95 % CI 1.08-2.82) than did longer courses (12-36 months) of DAPT. A risk-benefit analysis identified 3 fewer deaths and 5 fewer bleeds but 4 more MIs and 3 more STs annually for every 1000 patients treated with the shorter courses. In the predominantly low-risk population enrolled in RCTs, limiting DAPT to 3 to 12 months after DES implantation saved lives and prevented bleeding at the expense of increased ST and MI.
authors.affiliation: Munroe Heart and Vascular Institute, Munroe Regional Medical Center, 1221 SE 5th Street, Ocala, FL, 34471, USA. jabittl@mac.com.
authors.forename: John A
authors.initials: JA
authors.lastname: Bittl
mesh_terms: D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000401:mortality / Q000517:prevention & control*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D006470:Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Antiplatelet therapy; Hemorrhage; Percutaneous coronary intervention; Randomized controlled trials