Abstract 12273: Benefits and Safety of Prolonged Dual Antiplatelet Therapy in Patients With Ischemic Cardiovascular Disease: A Meta-analysis of 18 Randomized Trials Including 94,306 Patients

Abstract

Introduction: The optimal duration of dual antiplatelet therapy (DAPT) in patients with ischemic cardiovascular (CV) disease is still debated. A previous meta-analysis demonstrated no benefit of prolonged DAPT on mortality. However, assessment of the risk and benefit of prolonging DAPT beyond current recommendations cannot overlook its effects on stroke, myocardial infarction (MI) and bleeding. Hypothesis: The purpose of this meta-analysis was to assess the effects of prolonged versus no or short-term DAPT on MI, stroke, bleeding and mortality. Methods: Trial inclusion criteria were: randomization to prolonged duration versus no or short DAPT; reporting of at least one outcome among overall and CV death, MI, stroke, major non-fatal bleeding, fatal and intracranial bleeding. Results: (Table) 18 randomized studies including 94,306 patients [mean age 64+2 years, 28% females, median follow-up 15 months (IQR:12-33)], were included. Prolonged DAPT, compared to no or short DAPT, significantly reduced MI by 21.3% and stroke by 18.8% but had no effect on overall or CV mortality. Prolonged DAPT significantly increased by 68.6% major non-fatal bleeding, but not intracranial or fatal bleeding. In patients with stable and unstable CV disease (with and without acute coronary syndrome, respectively) the effects of prolonged DAPT, compared to no or short DAPT, were equivalent to those observed in the main analysis. DAPT prolonged beyond 1 year, as compared with shorter or no DAPT, significantly reduced MI but not stroke, all-cause or CV death. It significantly increased the risk of major non-fatal bleeding, with no difference in intracranial and fatal bleeding. Conclusions: Prolonged DAPT significantly reduces ischemic CV events but not mortality. Even if a significant increase of major non-fatal bleeding was detected, no increased risks of intracranial and fatal bleeding were observed.