Efficacy and safety of short-term (≤6 months) duration of dual antiplatelet therapy after drug-eluting stents: a meta-analysis of randomized controlled trials.

Abstract

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.