Optimize the duration of DAPT following DES implantation: An updated system review and meta-analysis of 10 randomized trials

Background

The appropriate duration of dual antiplatelet therapy (DAPT) with aspirin and a thienopyridine following drug-eluting stenting in percutaneous coronary intervention (PCI) remains uncertain.

Methods and results

A systemic search was conducted in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), for randomized trials evaluating the relative efficacy and safety performance of an extended with a control duration DAPT after drug-eluting stents (DES) implantation. Ten trials including 32,135 patients were included. Compared with DAPT of 3 to 6 months, an extended DAPT duration of 12 months or longer significantly increased risk of major bleeding by 90% (RR: 1.90, 95% CI: 1.23 to 2.94, p = 0.004), but did not reduced incidences of any documented ischemic events. Compared with 12-month duration, a more extended DAPT (18 to 30 months) significantly increased risk of all-cause death (RR: 1.30, 95% CI: 1.02 to 1.65, p = 0.035) and major bleeding (RR: 1.61, 95% CI: 1.25 to 2.07, p < 0.001), decreased risk of myocardial infarction (RR: 0.53, 95% CI: 0.43 to 0.66, p < 0.001) and stent thrombosis (RR: 0.33, 95% CI: 0.21 to 0.51, p < 0.001), no difference was detected regarding cardiac death and stroke.

Conclusions

A short DAPT (3 to 6 months) decreases major bleeding while maintains antithrombotic efficacy compared with an extended DAPT (≥ 12 months). A more extended DAPT (18 to 30 months) decreases ischemic events, whereas increases risks of all-cause death and major bleeding than standard 12-month therapy. A 3-to-6-month DAPT might be preferable for a broad group of patients undergoing DES implantation.