Journal
EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY
Volume 8, Issue 1, Pages 56-64Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ehjcvp/pvaa127
Keywords
Dual antiplatelet therapy; Drug-eluting stent; Very short; Short; Percutaneous coronary intervention; Acute coronary syndromes
Ask authors/readers for more resources
Short and very short DAPT have similar efficacy to standard DAPT after DES implantation, while extended DAPT reduces the risk of MI. Very short DAPT followed by a P2Y(12) inhibitor is preferred to balance major bleeding and ischemic events.
Aims To compare the safety and efficacy of very short (<= 3 months), short (6 months), standard (12 months), and extended (>12 months) dual antiplatelet therapy (DAPT), and of subsequent monotherapies, after coronary drugeluting stent (DES) implantation. Methods and results Twenty-two randomized control trials (n = 110 059 patients/year) were selected and included in a Bayesian network meta-analysis. The primary efficacy endpoint (PEP) was a composite of cardiac death, myocardial infarction (MI), and stent thrombosis (ST), with each of the components of the PEP being a secondary efficacy endpoint. The primary safety endpoint was major bleeding rate. Compared to standard, we found a lower rate of MI [odds ratio (OR) 0.56, 95% confidence interval (CI) 0.44-0.77] in extended, a lower rate of major bleeding (OR 0.61, 95% CI 0.39-0.87) in very short, and a lower rate of any bleeding (OR 0.61, 95% CI 0.38-0.90) in short DAPT. All DAPT durations were comparable regarding the secondary efficacy endpoints. Very short DAPT followed by P2Y(12) inhibition was the treatment of choice to reduce both major bleeding and MI. In the ACS subgroup, extended DAPT (as compared to standard) reduced PEP and ST rates (but not MIs). Conclusion The efficacy of short and very short is comparable with that of standard DAPT after DES implantation, whereas extended DAPT reduces MI rate. Very short DAPT is associated with lower haemorrhagic events and, followed by a P2Y(12) inhibitor monotherapy, should be preferred in order to pursue a trade-off between major bleeding and ischaemic events.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available