Optimal Duration of Dual Antiplatelet Therapy After Drug-eluting Stent Implantation: A Meta-analysis of 3 Randomized Controlled Trials

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Abstract

Purpose:

The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is still unclear. We conducted a meta-analysis of randomized trials to assess the optimal duration of DAPT after DES implantation.

Methods:

Articles were identified through a literature search of EMBASE, Pubmed, Europubmed, and the Cochrane Library until November 2013. Data were independently extracted by 2 reviewers. A random effect model was used to calculate the pooled odds ratios (ORs) with 95% confidence intervals (CIs) of the clinical outcomes concerned.

Results:

Three randomized controlled trials with zotarolimus- or everolimus-eluting stents and 6679 patients were included. There were no significant differences between short-term DAPT and standard-term DAPT in the comparison of incidences of cardiac death (OR, 0.84; 95% CI, 0.53–1.35; P = 0.48), myocardial infarction (OR, 1.21; 95% CI, 0.83–1.75; P = 0.32), stent thrombosis (OR, 1.30; 95% CI, 0.50–3.39; P = 0.59), and target vessel revascularization (OR, 1.16; 95% CI, 0.89–1.52; P = 0.26). Short-term DAPT did not increase the risk of all-cause death (OR, 0.86; 95% CI, 0.59–1.26; P = 0.44), cerebrovascular accidents (OR, 0.88; 95% CI, 0.421.81; P = 0.72), and major bleeding events (OR, 0.59; 95% CI, 0.30–1.15; P = 0.12).

Conclusions:

The results indicate that short-term DAPT do not increase the risk of cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, major bleeding, cerebrovascular accidents, and all-cause death at 12 months after implantation of DES compared with current standard-term DAPT. However, only 3 studies with second generation of DES are included in this meta-analysis. Further well-designed studies are still needed.

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