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BMJ. 2015 Apr 16;350:h1618. doi: 10.1136/bmj.h1618.

Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials.

Author information

1
Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany eliano.navarese@alice.it.
2
Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany Department of Cardiovascular Science, Catholic University, Rome, Italy.
3
Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany.
4
Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, 40225 Düsseldorf, Germany Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus, Toruń, Poland.
5
Department of Cardiovascular Science, Catholic University, Rome, Italy Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany.
6
Department of Cardiology, University Medical Centre St Radboud, Nijmegen, Netherlands Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany.
7
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.
8
Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany Department of Cardiology, 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland.
9
Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, University of Milan-Bicocca, Milan, Italy.
10
Department of Cardiology, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE research network, Düsseldorf, Germany.

Abstract

OBJECTIVE:

To assess the benefits and risks of short term (<12 months) or extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12 month therapy, following percutaneous coronary intervention with drug eluting stents.

DESIGN:

Meta-analysis of randomised controlled trials.

DATA SOURCES:

PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library, and major congress proceedings, searched from 1 January 2002 to 16 February 2015.

REVIEW METHODS:

Trials comparing short term (<12 months) or extended (>12 months) DAPT regimens with standard 12 month duration of therapy. Primary outcomes were cardiovascular mortality, myocardial infarction, stent thrombosis, major bleeding, and all cause mortality.

RESULTS:

10 randomised controlled trials (n=32,287) were included. Compared to 12 month DAPT, a short term course of therapy was associated with a significant reduction in major bleeding (odds ratio 0.58 (95% confidence interval 0.36 to 0.92); P=0.02) with no significant differences in ischaemic or thrombotic outcomes. Extended versus 12 month DAPT yielded a significant reduction in the odds of myocardial infarction (0.53 (0.42 to 0.66); P<0.001) and stent thrombosis (0.33 (0.21 to 0.51); P<0.001), but more major bleeding (1.62 (1.26 to 2.09); P<0.001). All cause but not cardiovascular death was also significantly increased (1.30 (1.02 to 1.66); P=0.03).

CONCLUSIONS:

Compared with a standard 12 month duration, short term DAPT (<12 months) after drug eluting stent implementation yields reduced bleeding with no apparent increase in ischaemic complications, and could be considered for most patients. In selected patients with low bleeding risk and very high ischaemic risk, extended DAPT (>12 months) could be considered. The increase in all cause but not cardiovascular death with extended DAPT requires further investigation.

PMID:
25883067
PMCID:
PMC4410620
DOI:
10.1136/bmj.h1618
[Indexed for MEDLINE]
Free PMC Article

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