Duration of DAPT After DES | Journal Scan
What is the optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) placement?
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.
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.
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.
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.
Clinical Topics: Invasive Cardiovascular Angiography and Intervention
Keywords: Drug-Eluting Stents, Stents, Thrombosis, Hemorrhage, Risk, Myocardial Infarction, Platelet Aggregation Inhibitors
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