Short- versus standard-term dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent implantation: A meta-analysis

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• 作者：Jade E. Basaraba ; BSc(Pharm) ; ACPR^a ; Arden R. Barry ; BSc ; BSc(Pharm) ; PharmD ; ACPR^b ; ^c ; ^{arden.barry@ubc.ca}
• 关键词：Coronary artery disease ; Acute coronary syndrome ; Dual antiplatelet therapy ; Antiplatelet agents ; Duration
• 刊名：Journal of Cardiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：69
• 期：1
• 页码：353-358
• 全文大小：1257 K
• 卷排序：69

文摘

Twelve months of dual antiplatelet therapy (DAPT) is recommended after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. However, certain clinical scenarios may require premature discontinuation of therapy (e.g. urgent surgical procedure, major bleeding). The objective of this systematic review and meta-analysis was to investigate clinically relevant outcomes associated with a shorter duration of DAPT after PCI with DES implantation.MethodsA systematic search of Medline and Embase (inception to December 2015) was conducted. Included were randomized controlled trials that compared 6 months (or less) of DAPT (defined as acetylsalicylic acid 75–200 mg daily and a P2Y12 inhibitor) to the standard of 12 months. Outcomes of interest included death (all-cause and cardiac), myocardial infarction (MI), definite/probable stent thrombosis, and bleeding (major and overall). An odds ratio (OR) and 95% confidence interval (CI) were calculated for each outcome using a random effects model.ResultsSix trials (five open-label, one double-blind) were included (N = 13,900). Four studies investigated 6 months of DAPT, and two studies investigated 3 months. Median follow-up was 12 months. There was no statistically significantly difference between groups regarding all-cause death (OR 0.88, 95% CI 0.64–1.20), cardiac death (OR 1.00, 95% CI 0.64–1.55), MI (OR 1.16, 95% CI 0.87–1.56), and stent thrombosis (OR 1.22, 95% CI 0.70–2.15). Both major and any bleeding were significantly decreased with shorter-term DAPT (OR 0.58, 95% CI 0.34–0.98, and OR 0.62, 95% CI 0.47–0.81, respectively).ConclusionsShorter duration (3–6 months) of DAPT, as compared to 12 months, was not associated with a higher risk of death, MI, or stent thrombosis, but a lower rate of major and overall bleeding.