title: Optimal duration of dual antiplatelet therapy following percutaneous coronary intervention: protocol for an umbrella review.
abstract: Although dual antiplatelet therapy (DAPT) is routinely given to patients after percutaneous coronary intervention (PCI) with stenting, the optimal duration is unknown. Recent evidence indicates there may be benefits in extending the duration beyond 12 months but such decisions may increase the risk of bleeding. Our objective is to provide a comprehensive overview of the literature for clinicians and policymakers via an umbrella review assessing the optimal duration of DAPT.
  
  
  
  We will perform a comprehensive search of the published and grey literature for systematic reviews involving randomised controlled trials (RCTs) assessing the optimal duration of DAPT following PCI with stenting. The intervention of interest is extended DAPT (beyond 12 months) compared with short-term DAPT (6-12 months). Studies will be selected for inclusion by two reviewers, and the quality will be assessed. The primary outcomes of interest are all-cause mortality and cardiovascular mortality. Secondary outcomes will be bleeding (major, minor and gastrointestinal), urgent target vessel revascularisation, major adverse cardiovascular events, myocardial infarction, stroke and stent thrombosis. Outcomes will be assessed while on DAPT and after withdrawal of DAPT. Data will be summarised with respect to the number of included RCTs, number of participants, effect estimates and heterogeneity. Data will be reported separately based on patient demographics, procedural parameters (eg, stent types, lesion complexity and concurrent disease) and clinical presentation (eg, acute coronary syndromes, infarct type).
  
  
  
  Our umbrella review aims to provide a comprehensive overview of the benefits and harms associated with extending DAPT beyond 12 months following PCI with stenting. The results of this review will inform clinical and policy decisions regarding the optimal treatment duration and reimbursement of DAPT following PCI with stenting. Results will be disseminated through a peer-reviewed publication and conference presentations. Ethics approval is not required for this study.
  
  
  
  CRD42016047735.
authors.affiliation: Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Jesse
authors.identifier: 0000-0002-2501-1641
authors.initials: J
authors.lastname: Elliott
authors.affiliation: Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Kelly
authors.affiliation: Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Zemin
authors.initials: Z
authors.lastname: Bai
authors.affiliation: Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Wenfei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Independent Contractor, Ottawa, Ontario, Canada.
authors.forename: Becky
authors.initials: B
authors.lastname: Skidmore
authors.affiliation: Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Ontario, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Boucher
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Derek Y F
authors.initials: DY
authors.lastname: So
authors.affiliation: Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
mesh_terms: D006801:Humans; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D017202:Myocardial Ischemia / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011182:Postoperative Care / Q000379:methods; D000078202:Systematic Reviews as Topic
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Dual antiplatelet therapy; Percutaneous intervention; Umbrella review