کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5968543 | 1576171 | 2015 | 9 صفحه PDF | دانلود رایگان |
- This is an updated meta-analysis following recently published RCTs.
- 8 RCTs were identified and 7 were included accounting for 16,318 patients.
- There was no significant difference in ischemic endpoints and mortality between short and long term DAPT.
- We found a significant reduction in risk of major bleeding and total bleeding with shorter duration of DAPT.
- 3 to 6Â months of DAPT in low risk patients appears safe with less bleeding, and no increase in thrombotic risk or mortality.
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 12Â months, 6 vs 12Â months, 6 vs 24Â months and 12 vs 24Â months 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 3-6Â months of DAPT against 12Â months, 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 6Â months, 3 vs 24Â months and 6 vs 24Â month duration of DAPT showed no significant differences in risk of death or MI, or revascularization between 3 or 6Â months and 24Â months. However, 24Â months of DAPT was associated with significantly more bleeding than 3 or 6Â months.Conclusions3 to 6Â months 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.
Journal: International Journal of Cardiology - Volume 181, 15 February 2015, Pages 331-339