title: Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: Meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  After implantation of drug-eluting stents (DES), patients usually receive 6-12months of dual antiplatelet therapy (DAPT). However, the optimal duration of DAPT is controversial. Therefore, we performed a meta-analysis of randomized controlled trials to assess the risks and benefits of different DAPT durations.
  
  
  METHODS
  We searched the literature using MEDLINE, Scopus, EMBASE, ISI Web of Science, Cochrane Library, ClinicalTrials.gov and recent conference proceedings, and included those trials randomizing patients to receive different durations of DAPT after DES implantation and reporting frequencies of cardiovascular and bleeding events. Data from eleven trials were analyzed using RevMan.
  
  
  RESULTS
  Compared to 12-month DAPT treatment, extended DAPT significantly reduced the frequencies of myocardial infarction (OR 0.54 95% CI: 0.43-0.66; p<0.00001) and stent thrombosis (OR 0.36 95% CI: 0.24-0.55; p<0.00001), but the risks of major bleeding (OR 1.54 95% CI 1.22-1.96) and all-cause mortality (OR 1.43 95% CI 1.14-1.81) were substantially increased. There was no significant difference in stroke, cardiovascular mortality or repeat revascularization. Compared to short-term DAPT, 12-month DAPT or longer was associated with increased major bleeds (OR 1.98 95% CI: 1.26-3.11). No significant differences were found in the risk of other primary outcomes.
  
  
  CONCLUSIONS
  12-month DAPT appears to be a pragmatic compromise between preventing stent thrombosis and increasing bleeding risk. Patients at high bleeding risk should have shorter duration DAPT while those with low bleeding risk can be considered for DAPT beyond 12months.
authors.affiliation: Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Fei
authors.affiliation: Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
authors.forename: Man Fung
authors.initials: MF
authors.lastname: Tsoi
authors.affiliation: Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; Partner State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China.
authors.forename: Tommy Tsang
authors.initials: TT
authors.lastname: Cheung
authors.affiliation: Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; Partner State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China; Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong, China; Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China. Electronic address: mycheung@hku.hk.
authors.forename: Bernard Man Yung
authors.initials: BM
authors.lastname: Cheung
mesh_terms: D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000639:trends*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Bleeding; Drug-eluting stent; Dual antiplatelet therapy; Meta-analysis