Duration of dual antiplatelet therapy after drug-eluting stent implantation: meta-analysis of randomised controlled trials

Abstract

INTRODUCTION: Patients are recommended for 6 to 12 months of dual antiplatelet therapy (DAPT) after drugeluting stents (DES) implantation. The optimal duration of DAPT has been debated. Therefore, this metaanalysis was conducted to evaluate safety and efficacy of different DAPT durations after DES implantation. METHODS: We searched the literature using MEDLINE, Scopus, EMBASE, ISI Web of Science, Cochrane Library, ClinicalTrials.gov, and recent conference proceedings. We included trials randomising patients to receive different durations of DAPT after DES implantation. Data were analysed with RevMan. RESULTS: Eleven randomised controlled trials with 23 559 patients were included for analysis with four trials comparing extended DAPT versus 12-month regimen and seven trials comparing short-term DAPT versus 12-month regimen. Compared to 12-month DAPT treatment, extended DAPT was significantly associated with lower frequency of myocardial infarctions (odds ratio [OR]=0.36; 95% confidence interval [CI], 0.24-0.55; P < 0.00001) but the risks of major bleeding (OR=1.54; 95% CI, 1.22-1.96) and all-cause mortality (OR=1.43; 95% CI, 1.14-1.81) were substantially increased. There was no significant difference in preventing stroke, cardiac mortality, and repeat revascularisation. Compared to shortterm DAPT, 12-month DAPT was associated with increased major bleeds (OR=1.98; 95% CI, 1.26-3.11). However, no significant alteration was found in the risk of other primary outcomes. CONCLUSION: Extended DAPT beyond 12 months yields benefits in reducing myocardial infarction and stent thrombosis, but it increases risk of bleeding and all-cause mortality. Discontinuation of DAPT before 12 months decreases number of major bleeds with no apparent difference in other primary endpoints.