A3825 Effectiveness and implications of six-month dual antiplatelet therapy following implanting drug-eluting stents

Abstract

Objectives: We aimed to compare and rank different durations of DAPT after DES placement for various clinical endpoints. Methods: We did a network meta-analysis comparing short-term (≤6 months)versus standard-term (12 months)versus long-term (≥18 months). We searched Medline, the Cochrane Library, Web of Science, Embase, and ClinicalTrials.gov on Jan 20th, 2018, for randomized controlled trials (RCTs) comparing different DAPT durations after DES's implantation. Analyses were done by both frequentist and Bayesian approaches. Results: We identified 14 eligible trials published between Jan 24, 2012 and June 26, 2017, including 40084 randomly assigned patients. The quality of evidence was rated as moderate in most comparisons. By frequentist network meta-analysis, we noticed long-term DAPT increased the risk of non-cardiac mortality compared with short-term DAPT (odds ratio[OR] 1.63, 95% CrI 1.00 to 2.65). We also found standard-term DAPT might mean less repeat revascularization than short-term (0.80, 0.65 to 0.99). According to our analyses, myocardial infarction (long vs. short: 0.54, 0.32 to 0.90) and stent thrombosis (long vs. short: 0.50, 0.28 to 0.90) decreased when DAPT was increased while major bleeding (long vs. short: 1.79, 1.25 to 2.55) was the opposite. No significant difference was notified in all-cause death, cardiac death, stroke and net adverse clinical events. Similar results were observed in a Bayesian framework. Conclusion: Compared with ≤6 month-DAPT, ≥18 month-DAPT was associated with higher rate of non-cardiac death, while 12-month DAPT decreased the risk of repeat revascularization and increased the risk of non-major bleeding simultaneously. However, when excluding effects of 3-month DAPT, no significant difference among endpoints was observed between 6 and 12-month DAPT.