Short Versus Long-Term Dual Antiplatelet Therapy in Patients at High Bleeding Risk Undergoing PCI in Contemporary Practice: A Systemic Review and Meta-analysis.
IF 3
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
引用次数: 1
Abstract
Introduction: Patients at high bleeding risk (HBR patients) represent an important subset of patients undergoing percutaneous coronary intervention (PCI). It remains unclear whether a shortened duration of dual antiplatelet therapy (DAPT) confers benefits compared with prolonged duration of DAPT in this patient population. The aim of this study was to investigate and compare bleeding and ischemic outcomes among HBR patients receiving short- versus long-term DAPT after PCI.
Methods: A meta-analysis of studies comparing short-term (1-3 months) and long-term (6-12 months) DAPT after PCI with second-generation drug-eluting stents in HBR patients was performed.
Results: Six studies [1 randomized controlled trial (RCT), 2 RCT subanalyses, and 3 prospective propensity-matched studies] involving 15,908 patients were included in the meta-analysis. During a follow-up of 12 months, short-term DAPT was associated with a reduction in major bleeding events [odds ratio (OR) 0.63, 95% confidence interval (CI) 0.42-0.95; p = 0.03, I2 = 71] and comparable definite/probable stent thrombosis, all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and ischemic stroke, compared with long-DAPT. Single antiplatelet therapy (SAPT) with aspirin was comparable to SAPT with P2Y12 inhibitor, with no treatment-by-subgroup interaction for major bleeding events (p-interaction = 0.27). In studies including patients presenting with MI, a trend of more frequent MI was noted in the short-DAPT arm (OR 1.25, 95% CI 0.98-1.59; p = 0.07; I2 = 0). In a sensitivity analysis comparing 3- and 12-month DAPT, the 3-month DAPT strategy was associated with a higher risk of ischemic stroke (OR 2.37, 95% CI 1.15-4.87; p = 0.02, I2 = 0%).
Conclusion: Short-term DAPT after PCI in HBR patients was associated a reduction in major bleeding events and similar ischemic outcomes. However, a higher risk of ischemic stroke and MI at 1 year of follow-up was seen in some subsets.
短期与长期双重抗血小板治疗在接受PCI的高出血风险患者的当代实践:系统回顾和荟萃分析。
高危出血患者(HBR患者)是接受经皮冠状动脉介入治疗(PCI)患者的重要组成部分。目前尚不清楚在该患者群体中，缩短双重抗血小板治疗(DAPT)的持续时间是否比延长DAPT的持续时间更有益处。本研究的目的是调查和比较HBR患者在PCI术后接受短期和长期DAPT的出血和缺血结局。方法:对HBR患者PCI术后短期(1-3个月)和长期(6-12个月)DAPT与第二代药物洗脱支架的研究进行meta分析。结果:meta分析纳入6项研究[1项随机对照试验(RCT)、2项RCT亚分析和3项前瞻性倾向匹配研究]，共15908例患者。在12个月的随访中，短期DAPT与大出血事件的减少相关[优势比(OR) 0.63, 95%可信区间(CI) 0.42-0.95;p = 0.03, I2 = 71]，与长时间dapt相比，明确/可能的支架血栓形成、全因死亡率、心血管死亡率、心肌梗死(MI)和缺血性卒中具有可比性。阿司匹林单次抗血小板治疗(SAPT)与P2Y12抑制剂的SAPT相当，对于主要出血事件没有亚组治疗相互作用(p相互作用= 0.27)。在包括出现心肌梗死患者的研究中，短dapt组出现心肌梗死更频繁的趋势(OR 1.25, 95% CI 0.98-1.59;p = 0.07;i2 = 0)。在比较3个月和12个月DAPT的敏感性分析中，3个月DAPT策略与缺血性卒中的高风险相关(OR 2.37, 95% CI 1.15-4.87;p = 0.02, I2 = 0%)。结论:HBR患者PCI术后短期DAPT与大出血事件和类似缺血结局的减少相关。然而，在一些亚群中，1年随访时缺血性卒中和心肌梗死的风险较高。
本文章由计算机程序翻译，如有差异，请以英文原文为准。
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来源期刊
Cardiology and Therapy
CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
5.30
自引率
0.00%
发文量
38
审稿时长
6 weeks
期刊介绍：
Aims and Scope
Cardiology and Therapy is an international, open access, peer reviewed (single-blind), rapid-publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of cardiovascular therapies and interventions, including devices. Studies relating to diagnosis and diagnostics, pharmacoeconomics, public health, quality of life, as well as patient care, management and education are also encouraged.
Areas of focus include, but are not limited to, ischaemic heart disease and acute cardiac care, myocardial, valvular, pericardial and congenital heart disease, vascular and pulmonary disease (including hypertension), arrhythmias, heart failure, non-invasive diagnostic techniques, and invasive and interventional cardiology as well as cardiovascular surgery.
The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols and short communications such as commentaries and editorials. Cardiolology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals.
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The journal’s publication timelines aim for a rapid peer review of 2 weeks. If an article is accepted it will be published 3–4 weeks from acceptance. The rapid timelines are achieved through the combination of a dedicated in-house editorial team, who manage article workflow, and an extensive Editorial and Advisory Board who assist with peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. Combined with the journal’s open access model this allows for the rapid, efficient communication of the latest research and reviews, fostering the advancement of cardiovascular therapies.
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The journal’s dedicated in-house editorial team offer a personal “concierge service” meaning authors will always have an editorial contact able to update them on the status of their manuscript. The editorial team check all manuscripts to ensure that articles conform to the most recent COPE, GPP and ICMJE publishing guidelines. This supports the publication of ethically sound and transparent research.
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