Optimize the duration of DAPT following DES implantation: An updated system review and meta-analysis of 10 randomized trials

Abstract

BackgroundThe appropriate duration of dual antiplatelet therapy (DAPT) with aspirin and a thienopyridine following drug-eluting stenting in percutaneous coronary intervention (PCI) remains uncertain. Methods and resultsA systemic search was conducted in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), for randomized trials evaluating the relative efficacy and safety performance of an extended with a control duration DAPT after drug-eluting stents (DES) implantation. Ten trials including 32,135 patients were included. Compared with DAPT of 3 to 6months, an extended DAPT duration of 12months or longer significantly increased risk of major bleeding by 90% (RR: 1.90, 95% CI: 1.23 to 2.94, p=0.004), but did not reduced incidences of any documented ischemic events. Compared with 12-month duration, a more extended DAPT (18 to 30months) significantly increased risk of all-cause death (RR: 1.30, 95% CI: 1.02 to 1.65, p=0.035) and major bleeding (RR: 1.61, 95% CI: 1.25 to 2.07, p<0.001), decreased risk of myocardial infarction (RR: 0.53, 95% CI: 0.43 to 0.66, p<0.001) and stent thrombosis (RR: 0.33, 95% CI: 0.21 to 0.51, p<0.001), no difference was detected regarding cardiac death and stroke. ConclusionsA short DAPT (3 to 6months) decreases major bleeding while maintains antithrombotic efficacy compared with an extended DAPT (≥12months). A more extended DAPT (18 to 30months) decreases ischemic events, whereas increases risks of all-cause death and major bleeding than standard 12-month therapy. A 3-to-6-month DAPT might be preferable for a broad group of patients undergoing DES implantation.