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Interrupting DAPT led to adverse events in some patients
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Interruption of dual antiplatelet therapy over 12 months after ACS was associated with an increase in adverse event risk in nearly 20% of patients who received stents. However, those who were managed conservatively were not at increased risk.
Researchers conducted a review of PubMed, Cochrane and Google Scholar databases with the aim of defining the optimal duration of DAPT following ACS hospitalization in patients treated medically and those who underwent percutaneous transluminal coronary angioplasty (PTCA).
Eligible participants presented with ACS and were treated with DAPT for a duration longer or shorter than 12 months. The researchers conducted a pooled multivariable risk analysis for death and recurrent ACS associated with stopping DAPT after 12 months in a cohort of 49,586 patients.
The median patient age was 66 (64-67) years. Sixty-seven percent (65-75) were men, and 88% (60-100) carried MI as the admission diagnosis. Stents were implanted in 66% (50-74) of the cohort.
The median follow-up duration was 2.1 years (1.5-2.7). At this time point, 40% were still receiving DAPT after 12 months, and the mortality or recurrent ACS rate was 16.6% (14.5-17.0).
Ceasing DAPT after 1 year was associated with a significant increase in adverse event risk in patients who received stents (OR=1.19; 1.07-1.32). Among patients managed with medical therapy, this risk was not significant (OR=1.13; 0.95-1.35).
Age, gender, MI status at admission or stent type did not impact adverse event risk.
“Interruption of DAPT over 12 months after ACS increases the risk of adverse events for patients treated with PTCA, but not for those managed conservatively, independently from baseline features and admission diagnosis,” the researchers concluded. “This hypothesis-generating finding should be tested in randomized controlled trials.”
Disclosure: The researchers report no relevant financial disclosures.
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