Safety of short-term dual antiplatelet therapy after drug-eluting stents: An updated meta-analysis with direct and adjusted indirect comparison of randomized control trials

Abstract

BackgroundDuration of dual antiplatelet therapy (DAPT) following drug-eluting stents (DES) remains controversial and is a topic of ongoing research. MethodsDirect and adjusted indirect comparisons of all the recent randomized control trials (RCTs) were performed to evaluate the safety of short-term versus long-term DAPT following DES. Results8 RCTs were identified and 7 (16,318 subjects) were included. 4 groups of 3 vs 12months, 6 vs 12months, 6 vs 24months and 12 vs 24months of DAPT were used for direct comparison. There was no significant difference in stent thrombosis, myocardial infarction (MI), stroke and revascularization, cardiovascular and all-cause mortality between the different durations in all 4 groups. Pooling trials of 3–6months of DAPT against 12months, we found a significant reduction in the risk of total bleeding (RR 0.61, 95% CI 0.43–0.87). Adjusted indirect comparison between 3 vs 6months, 3 vs 24months and 6 vs 24month duration of DAPT showed no significant differences in risk of death or MI, or revascularization between 3 or 6months and 24months. However, 24months of DAPT was associated with significantly more bleeding than 3 or 6months. Conclusions3 to 6months of DAPT following second generation DES and above is safe with no increased risk of thrombotic complications and mortality, and lower bleeding risk. However a tailored approach may be more appropriate for high-risk patients.