Safety of short-term dual antiplatelet therapy after drug-eluting stents:An updated meta-analysis with direct and adjusted indirect comparison of randomized control trials

Bulluck, Heerajnarain, Kwok, Chun Shing, Ryding, Alisdair D. and Loke, Yoon K. (2015) Safety of short-term dual antiplatelet therapy after drug-eluting stents:An updated meta-analysis with direct and adjusted indirect comparison of randomized control trials. International Journal of Cardiology, 181. pp. 331-339. ISSN 0167-5273

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Abstract

Background: Duration of dual antiplatelet therapy (DAPT) following drug-eluting stents (DES) remains controversial and is a topic of ongoing research. Methods: Direct and adjusted indirect comparisons of all the recent randomized control trials (RCTs) were performed to evaluate the safety of short-term versus long-term DAPT following DES. Results: 8 RCTs were identified and 7 (16,318 subjects) were included. 4 groups of 3 vs 12 months, 6 vs 12 months, 6 vs 24 months and 12 vs 24 months of DAPT were used for direct comparison. There was no significant difference in stent thrombosis, myocardial infarction (MI), stroke and revascularization, cardiovascular and all-cause mortality between the different durations in all 4 groups. Pooling trials of 3–6 months of DAPT against 12 months, we found a significant reduction in the risk of total bleeding (RR 0.61, 95% CI 0.43–0.87). Adjusted indirect comparison between 3 vs 6 months, 3 vs 24 months and 6 vs 24 month duration of DAPT showed no significant differences in risk of death or MI, or revascularization between 3 or 6 months and 24 months. However, 24 months of DAPT was associated with significantly more bleeding than 3 or 6 months. Conclusions: 3 to 6 months of DAPT following second generation DES and above is safe with no increased risk of thrombotic complications and mortality, and lower bleeding risk. However a tailored approach may be more appropriate for high-risk patients. Keywords: Percutaneous coronary intervention; Drug-eluting stent; Acute coronary syndrome; Dual antiplatelet treatment; Duration of therapy

Item Type: Article
Uncontrolled Keywords: percutaneous coronary intervention,drug-eluting stent,acute coronary syndrome,dual antiplatelet treatment,duration of therapy
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 19 Dec 2015 07:20
Last Modified: 22 Apr 2020 00:47
URI: https://ueaeprints.uea.ac.uk/id/eprint/55805
DOI: 10.1016/j.ijcard.2014.12.037

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