Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials.

Costa, Francesco; Montalto, Claudio; Branca, Mattia; Hong, Sung-Jin; Watanabe, Hirotoshi; Franzone, Anna; Vranckx, Pascal; Hahn, Joo-Yong; Gwon, Hyeon-Cheol; Feres, Fausto; Jang, Yangsoo; De Luca, Giuseppe; Kedhi, Elvin; Cao, Davide; Steg, Philippe Gabriel; Bhatt, Deepak L; Stone, Gregg W; Micari, Antonio; Windecker, Stephan; Kimura, Takeshi; ... (2023). Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials. European Heart Journal, 44(11), pp. 954-968. Oxford University Press 10.1093/eurheartj/ehac706

Preview	Text Costa_EurHeartJ_2022_AAM.pdf - Accepted Version Available under License Publisher holds Copyright. Download (2MB) | Preview
	Text Costa_EurHeartJ_2023.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Authors hold Coppyright Download (2MB)
Preview	Text Costa_EurHeartJ_2022_supplmat.pdf - Supplemental Material Available under License Publisher holds Copyright. Download (1MB) | Preview

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.

Interest & Impact

Downloads

33 since deposited on 13 Dec 2022
29 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item