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DAPT duration impacts clinical outcomes after DES implantation
Duration of dual antiplatelet therapy was associated with rates of MI and major bleeding in patients undergoing drug-eluting stent implantation, recently published data indicate.
In a meta-analysis, the researchers evaluated data from five randomized controlled trials that included 19,760 patients — 9,810 of whom were randomly assigned to short-duration DAPT (3 to 6 months) and 9,950 of whom were assigned to long-duration DAPT (12 to 30 months). The mean follow-up period was 29.4 months.
“A major limitation of most randomized controlled trials and previous meta-analyses was a short period of follow-up,” study researcher Abhishek Sharma, MD, from the division of cardiovascular medicine at the State University of New York Downstate Medical Center, said in a press release. “Between the small number of stent thrombosis events due to the low risk of stent thrombosis with newer-generation DES and the possibility that very-late stent thrombosis events were not captured due to inadequate follow-up, individual trials and even previous meta-analyses were probably underpowered to detect a definitive difference in reduction of very-late stent thrombosis with long-duration DAPT. This limitation was addressed in our study by pooling data from only those randomized controlled trials that have reported outcomes after a follow-up of at least 24 months or longer.”
Results linked short-duration DAPT, compared with long-duration DAPT, to a higher rate of MI (3.12% vs. 1.88%; OR = 1.48; 95% CI, 1.04-2.1) but a lower rate of TIMI major bleeding (0.81% vs. 1.28%; OR = 0.64; 95% CI, 0.41-0.99). The researchers noted moderate heterogeneity among the five studies for MI (I2 = 61%) but low heterogeneity for TIMI major bleeding (I2 = 0%).
However, data demonstrated no differences between long-duration and short-duration DAPT in the rates of stent thrombosis (0.45% vs. 0.99%; OR = 1.59; 95% CI, 0.77-3.27), all-cause mortality (2.41% vs. 2.19%; OR = 0.9; 95% CI, 0.73-1.12) and cardiac mortality (1.3% vs. 1.34%; OR = 1.03; 95% CI, 0.81-1.31).
There were also no significant differences between short- vs. long-duration DAPT in the rates of target vessel revascularization (2.68% vs. 3.04%; OR = 0.87; 95% CI, 0.67-1.14) or stroke (0.95% vs. 0.87%; OR = 1.08; 95% CI, 0.81-1.46).
“Our results support the importance of carefully choosing DAPT durations based on an individual patient's ischemic and bleeding risks,” Sharma said. “However, the clinical trials included in the current meta-analysis have mostly used clopidogrel as the second agent. With increasing adoption of more potent P2Y12 inhibitors in clinical practice, the relative benefit-to-risk profile of shorter-duration DAPT vs. longer-duration DAPT using these agents remains to be established in future studies.” – by Melissa Foster
Disclosure s : Cardiology Today’s Intervention could not obtain relevant financial disclosures.