Abstract
While dual antiplatelet therapy (DAPT) is essential after percutaneous coronary intervention (PCI), the optimal duration is affected by various factors. However, the effect of ethnicity on DAPT duration has not been fully evaluated. In this study, we evaluated the different effect of DAPT duration by ethnicity. We searched Pubmed, Embase, Cochrane library, and relevant websites to search for randomized clinical trials (RCT) assessing the clinical impact of long term DAPT (L-DAPT) and short term DAPT (S-DAPT). Studies were divided by ethnicity, and we compared the efficacy and safety of DAPT duration in each ethnic group. Thirteen RCTs including 38,255 patients (five East Asian studies and eight non–East Asian studies) were eligible for analysis. For the primary outcome, L-DAPT showed a significantly lower rate of primary outcome only in non–East Asians (S-DAPT vs. L-DAPT, odds ratio (OR) = 1.16, 95% confidence interval (CI): 1.02–1.32, p = 0.02), while in East Asians, the effect of S-DAPT and L-DAPT were comparable. S-DAPT significantly increased ischemic events only in non–East Asians (S-DAPT vs. L-DAPT, OR = 1.24, 95% CI: 1.09–1.42, p <0.01), while bleeding events were decreased by S-DAPT in both ethnicities. These results demonstrate that the adequate DAPT duration after PCI may be different in East Asians.
Highlights
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is recommended after percutaneous coronary intervention (PCI) to reduce stent thrombosis (ST) and ischemic events [1]
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Our data suggest that the ischemia/bleeding tradeoff and the therapeutic range of DAPT may be different between East Asians and non–East Asians
Summary
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is recommended after percutaneous coronary intervention (PCI) to reduce stent thrombosis (ST) and ischemic events [1]. The Academic Research Consortium (ARC) has published a white paper to define high bleeding risk (HBR) stressing the careful usage of DAPT in patients undergoing PCI [3]. Because more and more candidates for PCI are at high risk of bleeding, it is not surprising that various clinical trials, including the LEADERS FREE trial and the ONYX ONE trial, are being conducted to confirm the safety of a shorter duration of DAPT in patients with HBR [4,5]. Among others, have reported that East Asians may have higher rates of bleeding but have comparable or lower rates of ischemic events than Caucasian patients [6,7,8,9]. In the current study, we performed a meta-analysis to compare the differences in the efficacy and safety of a short course of DAPT among East Asians and non–East Asians to add to the evidence on the relationship between ethnicity and duration of DAPT
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