Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials
Year: 2022
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: AIMS: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) is still debated. The current study, using the totality of existing evidence, evaluated the impact of an abbreviated DAPT regimen in HBR patients. METHODS AND RESULTS: A systematic review and meta-analysis was performed to search randomized clinical trials comparing abbreviated [i.e. very-short (1 month) or short (3 months)] with standard (≥6 months) DAPT in HBR patients without indication for oral anticoagulation. A total of 11 trials, including 9006 HBR patients, were included. Abbreviated DAPT reduced major or clinically relevant non-major bleeding [risk ratio (RR): 0.76, 95% confidence interval (CI): 0.61-0.94; I2 = 28%], major bleeding (RR: 0.80, 95% CI: 0.64-0.99, I2 = 0%), and cardiovascular mortality (RR: 0.79, 95% CI: 0.65-0.95, I2 = 0%) compared with standard DAPT. No difference in all-cause mortality, major adverse cardiovascular events, myocardial infarction, or stent thrombosis was observed. Results were consistent, irrespective of HBR definition and clinical presentation. CONCLUSION: In HBR patients undergoing PCI, a 1- or 3-month abbreviated DAPT regimen was associated with lower bleeding and cardiovascular mortality, without increasing ischaemic events, compared with a ≥6-month DAPT regimen. STUDY REGISTRATION: PROSPERO registration number CRD42021284004.
Source: European Heart Journal
Authors: Francesco Costa, Claudio Montalto, Mattia Branca, Sung-Jin Hong, Hirotoshi Watanabe, Anna Franzone, Pascal Vranckx, Joo-Yong Hahn, Hyeon-Cheol Gwon, Fausto Feres, Yangsoo Jang, Giuseppe De Luca, Elvin Kedhi, Davide Cao, Philippe Gabriel Steg, Deepak L Bhatt, Gregg W Stone, Antonio Micari, Stephan Windecker, Takeshi Kimura, Myeong-Ki Hong, Roxana Mehran, Marco Valgimigli
Institutions: University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, University of Bern, Severance Hospital, Yonsei University Health System, Hirakata Kohsai Hospital, Federico II University Hospital, Jessa Hospital, Hartcentrum Hasselt, Hasselt University, Samsung Medical Center, Sungkyunkwan University, Instituto Dante Pazzanese de Cardiologia, CHA University Bundang Medical Center, CHA University, Azienda Ospedaliero Universitaria di Sassari, Université Libre de Bruxelles, Erasmus Hospital, IRCCS Humanitas Research Hospital, Inserm, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Brigham and Women's Hospital, Harvard University, Mount Sinai Hospital, University Hospital of Bern, Istituto Cardiocentro Ticino, Università della Svizzera italiana
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4310962689