Duration of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention for bifurcation lesions: a systematic review and meta-analysis.

Dual antiplatelet therapy (DAPT) is used in patients after drug-eluting stent (DES) implantation to prevent stent thrombosis and ischemic events. The ideal duration of DAPT in patients after DES implantation is a topic of debate among clinicians. In the past, many research studies were published related to an optimal duration of DAPT after DES implantation.In common practice, DAPT should be continued for one year or more after percutaneous coronary intervention (PCI) followed by DES implantation. The duration of DAPT is significant as long-term DAPT has beneficial effects but is associated with side effects like bleeding. On the other hand, short-term DAPT has a lower risk of bleeding, but it increases the rate of stent thrombosis or ischemic events. Our aim in this systematic review is to solve the dispute regarding the duration of DAPT after DES implantation. So, we tried to find the efficacy and safety of short-term (six months) DAPT by compiling data from randomized control trials (RCTs). We conducted this systematic review following the guidelines defined in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. We searched for our data from multiple databases like PubMed, Web of Science, ScienceDirect, and Google Scholar. We reviewed 10964 studies and then applied inclusion/exclusion criteria and PRISMA guidelines. Finally, we were left with only 21 studies regarding the optimal duration of DAPT after DES implantation. Our systematic review will help determine the non-inferiority of short-term (six months) DAPT to long-term (12 months) DAPT. Furthermore, we also noticed with short-term (six months) DAPT, there was decreased incidence of bleeding as compared to DAPT for long-term. But more studies were required to establish the safety and effectiveness of short-term (six months) DAPT compared to long-term (12 months) DAPT in patients after DES implantation.

Dual antiplatelet therapy (DAPT) is the primary medication for patients after percutaneous coronary intervention (PCI). However, the best DAPT duration is still controversial. This systematic review and meta-analysis aims to assess the safety and effectiveness of short-term (3-6 months) DAPT compared to long-term (12 months) DAPT. We searched PubMed, Embase, Cochrane Library, and Web of Science systematically for all the randomized controlled trials (RCTs) which compared the different strategies for DAPT in patients undergoing PCI within ten years prior to January 2021. Major bleeding and any bleeding were identified as the safe endpoints. All causes of death, cardiac death, myocardial infarction, definite/probable stent thrombosis, target vessel revascularization, and stroke were identified as the efficacy endpoints. The hazard ratio (HR) and 95% confidence interval (CI) in each study were abstracted. Overall, 11 trials and 24,242 patients were included in this meta-analysis with 15-month median follow-up time. Short-term DAPT was related to reduced risks of major bleeding (HR 0.65, 95% CI 0.48-0.89) and any bleeding (HR 0.64, 95% CI 0.53-0.79). No obvious differences in any of the other endpoints were observed. In acute coronary syndrome (ACS) patients with drug-eluting stents (DES), short-term compared with long-term DAPT was related to a decreased risk of major bleeding (HR 0.57, 95% CI 0.37-0.87) without significant increasing in the risks of any bleeding and ischemic endpoints. Furthermore, short-term DAPT followed by P2Y12 receptor inhibitor monotherapy appreciably lowered the risk of major bleeding (HR 0.64, 95% CI 0.42-0.96) and any bleeding (HR 0.58, 95% CI 0.36-0.93). There were no obvious differences concerning death between the different strategies for DAPT. After PCI with DES, short-term DAPT is safer than long-term DAPT, and is not inferior in effectiveness, even in ACS patients. P2Y12 receptor inhibitor monotherapy following short-term DAPT is also related to a decreased risk of bleeding and may be an alternative anti-platelet strategy.

Patients at high bleeding risk (HBR patients) represent an important subset of patients undergoing percutaneous coronary intervention (PCI). It remains unclear whether a shortened duration of dual antiplatelet therapy (DAPT) confers benefits compared with prolonged duration of DAPT in this patient population. The aim of this study was to investigate and compare bleeding and ischemic outcomes among HBR patients receiving short- versus long-term DAPT after PCI. A meta-analysis of studies comparing short-term (1-3months) and long-term (6-12months) DAPT after PCI with second-generation drug-eluting stents in HBR patients was performed. Six studies [1 randomized controlled trial (RCT), 2 RCT subanalyses, and 3 prospective propensity-matched studies] involving 15,908 patients were included in the meta-analysis. During a follow-up of 12months, short-term DAPT was associated with a reduction in major bleeding events [odds ratio (OR) 0.63, 95% confidence interval (CI) 0.42-0.95; p = 0.03, I2 = 71] and comparable definite/probable stent thrombosis, all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and ischemic stroke, compared with long-DAPT. Single antiplatelet therapy (SAPT) with aspirin was comparable to SAPT with P2Y12 inhibitor, with no treatment-by-subgroup interaction for major bleeding events (p-interaction = 0.27). In studies including patients presenting with MI, a trend of more frequent MI was noted in the short-DAPT arm (OR 1.25, 95% CI 0.98-1.59; p = 0.07; I2 = 0). In a sensitivity analysis comparing 3- and 12-month DAPT, the 3-month DAPT strategy was associated with a higher risk of ischemic stroke (OR 2.37, 95% CI 1.15-4.87; p = 0.02, I2 = 0%). Short-term DAPT after PCI in HBR patients was associated a reduction in major bleeding events and similar ischemic outcomes. However, a higher risk of ischemic stroke and MI at 1 year of follow-up was seen in some subsets.

The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is under controversial. The aim of the present systematic review and meta-analysis was to evaluate the safety and efficacy of short-term (≤6months) DAPT vs long-term (≥12months) DAPT after PCI with a drug-eluting stent (DES). We systematically searched the Cochrane Library, PubMed and Embase databases to identify randomised controlled trials (RCTs) that compared short-term (≤6months) and long-term (≥12months) DAPT. The endpoints included major bleeding, any bleeding, death from any cause, cardiac death, myocardial infarction, stroke, stent thrombosis and target vessel revascularisation. The primary outcome was major bleeding. A fixed-effects model was used to calculate the risk ratio (RR) and 95% confidence interval (CI) of each endpoint. Eighteen trials involving 57,940 patients were included. Compared with long-term DAPT, short-term DAPT resulted in lower rates of major bleeding [RR 0.75, 95% CI 0.65-0.87, P=.0002] and any bleeding [RR 0.61, 95% CI 0.54-0.69, P<.00001]. No significant difference was observed in the outcomes of death from any cause, cardiac death, myocardial infarction, stroke, stent thrombosis, or target vessel revascularisation. The subgroup analysis according to different DAPT durations, mono antiplatelet therapies (MAPTs), countries and P2Y12 inhibitors produced similar outcomes as comprehensive outcomes. Compared with long-term DAPT, short-term DAPT did not increase the risk of ischemic complications but did reduce the risks of major bleeding and any bleeding by over 25%. This study showed that short-term DAPT could be considered for most patients after DES implantation.

Objective:Optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation remains controversial. The present study is an assessment of efficacy and safety of short-term (≤6 months) DAPT after DES implantation in patients with coronary artery disease, especially in important subgroups.Methods:PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized, controlled trials comparing short-term and long-term (>6 months) DAPT after DES implantation. Primary efficacy outcome was stent thrombosis (ST). Primary safety outcome was major bleeding. Pooled relative risks (RRs) with 95% confidence interval (CI) were calculated using random- or fixed-effects models as appropriate.Results:Total of 7 trials involving 15870 patients were included in the study. Short-term DAPT significantly reduced major bleeding by 49% compared with long-term DAPT (RR 0.51; 95% CI 0.32–0.80; p=0.003) without increasing risk of ST (RR 1.28; 95% CI 0.83–1.97; p=0.266). In addition, no differences were observed in all-cause mortality, myocardial infarction (MI), cardiac mortality, or cerebrovascular accidents. Moreover, no significant difference in composite of cardiovascular events, bleeding, and mortality was found in important clinical subgroups.Conclusion:Short-term DAPT is associated with lower bleeding risk compared with long-term DAPT. Number of ST and MI was higher with short-term DAPT without reaching statistical significance. Comprehensive clinical judgment is necessary to weigh benefits and risks in the individual patient.

The optimal duration of dual antiplatelet therapy (DAPT) following drugeluting stent (DES) implantation remains a subject of an ongoing debate. MEDLINE, EMBASE, Scopus and CENTRAL databases were searched for eligible randomized controlled trials (RCTs) that compared short-term (￡ 6 months) DAPT with long-term (≥ 12 months) DAPT following DES implantation. The primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), stroke, or major bleeding. The secondary outcome were the individual components of the primary outcome, cardiovascular death, stent thrombosis and any bleeding episode. A total of 15,378 patients from 7 RCTs were studied. There were no statistically significant differences between the short-term and long-term DAPT groups with respect to the occurrence of the primary outcome (risk ratio [RR] 1.017; 0.872-1.186; I2 = 0%), all cause death (RR 0.896; 0.708-1.134), cardiovascular death (RR 0.924; 0.668-1.279), MI (RR 1.139; 0.887-1.461), TVR (RR 1.174; 0.916-1.505), stent thrombosis (RR 1.264; 0.786-2.032), and stroke (RR 0.876; 0.685-1.611). However, there was a statistically significant lower risk of major bleeding in the short-term DAPT group (RR 0.57; 0.36-0.90; p = 0.02). There were no statistically significant differences in the sub-group analysis of patients with diabetes and patients presenting with acute coronary syndrome, RR 1.029; 0.745-1.421 and RR 1.062; 0.785-1.438, respectively. There was no difference in efficacy outcomes between short-term and long-term DAPT following DES, even among high-risk patients. However, longer duration of DAPT was found to be associated with increased risk of major bleeding.

Introduction: There is no end in sight to the ongoing debate on the optimal duration of dual antiplatelet therapy (DAPT) following drug-eluting coronary stent (DES) implantation. Hypothesis: Short-term DAPT is less effective than long-term DAPT in preventing adverse cardiovascular and cerebrovascular outcomes following DES. Methods: MEDLINE, EMBASE, Scopus and CENTRAL were searched for eligible randomized controlled trials (RCTs) that compared short-term (≤ 6 months) DAPT with long-term (≥ 12 months) DAPT following DES implantation. The primary end point was a composite of all cause death, myocardial infarction, target vessel revascularization, stroke or major bleeding. The secondary outcome were the individual components of the primary outcome, cardiovascular death, stent thrombosis and any bleeding episode. Results: A total of 15,378 patients from 7 RCTs were studied. There was no statistically significant difference between the short-term and long-term DAPT groups with respect to the occurrence of the primary outcome {Risk ratio (RR) 1.017 (0.872-1.186), I2 = 0%}, all cause death {RR 0.896 (0.708-1.134)}, cardiovascular death {RR 0.924 (0.668-1.279)}, myocardial infarction {RR 1.139 (0.887-1.461)}, target vessel revascularization {RR 1.174 (0.916-1.505)}, stent thrombosis {RR 1.264 (0.786-2.032)} and stroke {RR 0.876 (0.685-1.611)}. However there was a statistically significant lower risk of major bleeding in the short-term DAPT group {RR 0.57 (0.36-0.90), p 0.02}. There was no statistically significant difference in the sub-group analysis of patients with diabetes and patients presenting with acute coronary syndrome, {RR 1.029 (0.745-1.421)} and {RR 1.062 (0.785-1.438)}, respectively. Conclusion: There was no difference in efficacy outcomes between short-term and long-term DAPT following DES, even among high-risk patients. Longer duration of DAPT was found to be associated with increased risk of major bleeding. These results are contrary to findings from the recently published DAPT trial. However, even though the DAPT trial reported a significant decrease in the incidence of stent thrombosis and major adverse cardiac and cerebrovascular events in the long-term DAPT group, there was a paradoxical increase in mortality.

The optimal duration of dual antiplatelet therapy (DAPT) is still controversial among East Asians. This meta-analysis was designed to evaluate the efficacy and safety of short-term (≤6 months) vs. long-term (≥12 months) DAPT in East Asians undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). PubMed, Embase, Web of Science and the Cochrane Library were searched for articles published up to 30 March 2020. Then meta-analysis was performed using RevMan 5.3 software. Nine studies with a total of 20 177 East Asian patients were included in this meta-analysis. In East Asian patients, short-term DAPT was associated with a lower incidence of major bleeding [odds ratio (OR) = 0.70, 95% confidence interval (CI) (0.49, 0.99), P = 0.04]. In the newer-generation DES subgroup, short-term DAPT was no less effective than long-term DAPT and resulted in a lower incidence of major bleeding [OR = 0.69, 95% CI (0.49, 0.98), P = 0.04]. In the subgroup of patients with acute coronary syndrome, there was no significant difference in the incidence of cardiac death, net adverse clinical and cerebral events (NACCE) and major bleeding between short-term and long-term DAPT. It was worth noting that in the subgroup of patients with diabetes mellitus, short-term DAPT was associated with a higher incidence of myocardial infarction [OR = 2.64, 95% CI (1.19, 5.88), P = 0.02] and NACCE [OR = 1.92, 95% CI (1.07, 3.43), P = 0.03]. The short-term DAPT (≤6 months) might be a better choice for East Asian patients undergoing PCI with DES, especially the newer-generation DES. However, for high-risk patients such as diabetes, the analysis supported the longer DAPT.

Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients: A Meta-Analysis of Individual Participant Data From 6 Randomized Trials

Risk of Early Adverse Events After Clopidogrel Discontinuation in Patients Undergoing Short-Term Dual Antiplatelet Therapy: An Individual Participant Data Analysis

BackgroundDiabetes is considered to be a high-risk factor for thromboembolic events. However, available data about the optimal dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) after second-generation drug-eluting stent (DES) implantation are scant.ObjectiveThe purpose of this study was to compare the impact of various DAPT durations on clinical outcomes in patients with DM after second-generation DES implantation.MethodsWe searched PubMed, Embase, and the Cochrane Library for studies that compared short-term (≤ 6 months) and long-term (≥ 12 months) DAPT in patients with DM. The primary endpoints were late (31–365 days) and very late (> 365 days) stent thrombosis (ST). The secondary endpoints included myocardial infarction (MI), target vessel recanalization (TVR), all-cause death, and major bleeding.ResultsSix randomized controlled trials, with a total of 3,657 patients with DM, were included in the study. In terms of the primary endpoint, there was no significant difference between the two groups in late (OR 1.15, 95% CI: 0.42–3.19, P = 0.79) or very late (OR 2.18, 95% CI: 0.20–24.18; P = 0.53) ST. Moreover, there was no significant difference in the secondary endpoints, including MI (OR 1.11, 95% CI: 0.72–1.71, P = 0.63), TVR (OR 1.31, 95% CI: 0.82–2.07, P = 0.26), all-cause death (OR 1.03, 95% CI: 0.61–1.75, P = 0.90) and major bleeding (OR 1.07, 95% CI: 0.34–3.40, P = 0.90) between the two groups.ConclusionOur study demonstrated that compared with long-term DAPT, short-term DAPT had no significant difference in the clinical outcomes of patients with DM implanted with second-generation DES.

Diabetes is considered to be a high-risk factor for thromboembolic events. However, available data about the optimal dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) after second-generation drug-eluting stent (DES) implantation are scant. The purpose of this study was to compare the impact of various DAPT durations on clinical outcomes in patients with DM after second-generation DES implantation. We searched PubMed, Embase, and the Cochrane Library for studies that compared short-term (≤ 6 months) and long-term (≥ 12 months) DAPT in patients with DM. The primary endpoints were late (31-365 days) and very late (> 365 days) stent thrombosis (ST). The secondary endpoints included myocardial infarction (MI), target vessel recanalization (TVR), all-cause death, and major bleeding. Six randomized controlled trials, with a total of 3,657 patients with DM, were included in the study. In terms of the primary endpoint, there was no significant difference between the two groups in late (OR 1.15, 95% CI: 0.42-3.19, P = 0.79) or very late (OR 2.18, 95% CI: 0.20-24.18; P = 0.53) ST. Moreover, there was no significant difference in the secondary endpoints, including MI (OR 1.11, 95% CI: 0.72-1.71, P = 0.63), TVR (OR 1.31, 95% CI: 0.82-2.07, P = 0.26), all-cause death (OR 1.03, 95% CI: 0.61-1.75, P = 0.90) and major bleeding (OR 1.07, 95% CI: 0.34-3.40, P = 0.90) between the two groups. Our study demonstrated that compared with long-term DAPT, short-term DAPT had no significant difference in the clinical outcomes of patients with DM implanted with second-generation DES.

Efficacy and safety of short-term 1–3 months versus standard 12 months dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized clinical trials

Patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are at increased risk for subsequent ischemic events. Short-term dual antiplatelet therapy (DAPT) (≤6 months) is inferior to standard or long-term DAPT in patients who undergo PCI for ACS events. We conducted a systematic review and meta-analysis of randomized controlled trials that compared short-term (≤6 months) to long-term (≥12 months) DAPT after PCI for ACS. We searched MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials database. Ten randomized controlled trials, including a total of 12 696 patients, met our inclusion criteria. For short-term DAPT, duration of therapy ranged from 3 to 6 months, while long-term DAPT ranged from 12 to 24 months. The majority of studies used clopidogrel and second-generation drug-eluting stents. No statistically significant difference was found between short-term and long-term DAPT with regard to myocardial infarction (odds ratio 1.21; 95% confidence interval 0.94-1.57; P = 0.14), stent thrombosis (odds ratio 1.54; 95% confidence interval 1.00-2.38; P = 0.052), or major bleeding events (odds ratio 0.74; 95% confidence interval 0.49-1.11; P = 0.14). There was no significant difference in all-cause mortality, cardiac death, or net adverse cardiac and cerebrovascular events. Our meta-analysis demonstrated that short-term DAPT (<6 months) after PCI for ACS was not associated with increased risk of myocardial infarction or stent thrombosis when compared to long-term DAPT.

The optimal duration of dual antiplatelet therapy (DAPT) for patients implanted with new-generation drug-eluting stents in East Asians is currently still controversial. The purpose of this meta-analysis was to investigate the efficacy and safety of short-term DAPT in patients with those. In this study, randomized controlled trials from PubMed, EMBASE, and Cochrane Library were searched to compare the efficacy and safety of short-term DAPT (6 months or less) with long-term DAPT (12 months or more) in patients implanted with new-generation drug-eluting stents in East Asian from inception to September 2020. The primary efficacy outcome was all-cause death, the primary safety outcome was major bleeding, and the secondary outcomes included cardiovascular death, myocardial infarction, definite or possible stent thrombosis, and stroke. A total of 6 randomized controlled trials with 15,688 patients met inclusion criteria; there were no significant differences in the incidence of all-cause death [risk ratio (RR), 1.03; 0.76-1.39; P = 0.856)], cardiovascular death (RR, 0.83; 0.55-1.24; P = 0.361), myocardial infarction (RR, 0.97; 0.72-1.31; P = 0.853), definite or possible stent thrombosis (RR, 1.52; 0.83-2.78; P = 0.170), and stroke (RR, 0.90; 0.61-1.31; P = 0.574) between short-term and long-term DAPTs. However, there was a significant difference in the risk of major bleeding (RR, 0.64; 0.49-0.85; P = 0.002) between the 2 groups. Compared with long-term DAPT, the short-term DAPT can reduce the risk of major bleeding without increasing the risk of death or ischemia for East Asians (Registered by PROSPERO, CRD42020213266).