Duration of DAPT After DES | Journal Scan

Mar 17, 2015
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Authors:
Palmerini T, Sangiorgi D, Valgimigli M, et al.
Citation:
Short- Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation: An Individual Patient Data Pairwise and Network Meta-Analysis. J Am Coll Cardiol 2015;65:1092-1102.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) placement?

Methods:

The authors performed an individual patient data pairwise and network meta-analysis to compare short-term DAPT duration (≤6 months) versus long-term (>1 year) DAPT duration as well as the specific duration of 3, 6, and 12 months of DAPT. The primary outcome was 1-year major adverse cardiac events (MACE), defined as composite of death, myocardial infarction, and definite/probable stent thrombosis.

Results:

Data from four trials enrolling 8,180 patients were pooled. Short-term MACE was associated with a similar rate of MACE at 1 year (hazard ratio [HR], 1.11; 95% confidence interval [CI], 0.86-1.43; p = 0.44) with lower risk of bleeding (HR, 0.66; 95% CI, 0.46-0.94; p = 0.03). In landmark analysis comparing discontinuation of DAPT and 1-year follow-up, the event rates were similar with no difference in MACE (HR, 1.2; 95% CI, 0.77-1.89; p = 0.42) and lower hazard of bleeding (HR, 0.44; 95% CI, 0.21-0.91; p = 0.03). In a network analysis, no difference in MACE was noted between those treated with 3-month versus 6-month versus 1 year of DAPT.

Conclusions:

The authors concluded that shorter duration of DAPT is associated with similar risk for MACE and lower risk of bleeding compared with prolonged DAPT after DES placement.

Perspective:

The results of this meta-analysis, suggesting that short-term DAPT is superior to 1 year of DAPT, are in contrast to the large DAPT trial (Mauri, et al., N Engl J Med 2014), where prolonged DAPT was associated with a reduction in ischemic events, an increase in bleeding events, and no difference in overall mortality. These contrasting results suggest that there is probably no DAPT duration that can be considered a universal fit for all patients, and DAPT duration should be individualized based on the ischemic and bleeding risk of each specific patient.

Keywords: Drug-Eluting Stents, Stents, Thrombosis, Hemorrhage, Risk, Myocardial Infarction, Platelet Aggregation Inhibitors


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