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Benenati S, Galli M, De Marzo V, et al. Very short vs. long dual antiplatelet therapy after second generation drug-eluting stents in 35 785 patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother. 2021;7(2):86-93doi: 10.1093/ehjcvp/pvaa001.
Benenati, S., Galli, M., De Marzo, V., Pescetelli, F., Toma, M., Andreotti, F., Della Bona, R., Canepa, M., Ameri, P., Crea, F., & Porto, I. (2021). Very short vs. long dual antiplatelet therapy after second generation drug-eluting stents in 35 785 patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials. European heart journal. Cardiovascular pharmacotherapy, 7(2), 86-93. https://doi.org/10.1093/ehjcvp/pvaa001
Benenati, Stefano, et al. "Very short vs. long dual antiplatelet therapy after second generation drug-eluting stents in 35 785 patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials." European heart journal. Cardiovascular pharmacotherapy vol. 7,2 (2021): 86-93. doi: https://doi.org/10.1093/ehjcvp/pvaa001
Benenati S, Galli M, De Marzo V, Pescetelli F, Toma M, Andreotti F, Della Bona R, Canepa M, Ameri P, Crea F, Porto I. Very short vs. long dual antiplatelet therapy after second generation drug-eluting stents in 35 785 patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother. 2021 Mar 15;7(2):86-93. doi: 10.1093/ehjcvp/pvaa001. PMID: 31942965.
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Eur Heart J Cardiovasc Pharmacother. 2021 Mar 15;7(2):86-93. doi: 10.1093/ehjcvp/pvaa001.

Very short vs. long dual antiplatelet therapy after second generation drug-eluting stents in 35 785 patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials.

European heart journal. Cardiovascular pharmacotherapy

Stefano Benenati, Mattia Galli, Vincenzo De Marzo, Fabio Pescetelli, Matteo Toma, Felicita Andreotti, Roberta Della Bona, Marco Canepa, Pietro Ameri, Filippo Crea, Italo Porto

Affiliations

  1. Dipartimento of Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Viale Benedetto XV 6, 16132, Genova, Italia.
  2. Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.
  3. Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
  4. Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, Largo Rosanna Benzi 10, 16132, Genova, Italia.

PMID: 31942965 DOI: 10.1093/ehjcvp/pvaa001

Abstract

AIM: To provide an updated assessment of the efficacy-safety profile of very short (1 or 3 months) dual antiplatelet therapy (DAPT) compared with long (12 months) DAPT in patients undergoing percutaneous coronary interventions (PCIs).

METHODS AND RESULTS: Seven randomized controlled trials (RCTs) comparing very short vs. long DAPT in 35 785 patients undergoing PCI were selected. The primary efficacy endpoint was major adverse cardiovascular events (MACE) and the primary safety endpoint trial-defined major bleeding through at least 1 year. Compared with longer duration, very short DAPT yielded comparable rates of MACE [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.84-1.03, P = 0.19], all-cause mortality (OR 0.92, 95% CI 0.80-1.06, P = 0.25), myocardial infarction (OR 1.01, 95% CI 0.88-1.15, P = 0.91), stroke (OR 1.04, 95% CI 0.72-1.50, P = 0.83), stent thrombosis (OR 1.05, 95% CI 0.80-1.37, P = 0.73), target vessel revascularization (OR 0.99, 95% CI 0.82-1.18, P = 0.89), and comparable net clinical benefit (OR 0.92, 95% CI 0.84-1.01, P = 0.08). Very short DAPT was associated with reduced rates of major bleeding (OR 0.61, 95% CI 0.40-0.94, P = 0.03) or any bleeding (OR 0.65, 95% CI 0.47-0.90, P = 0.009). Subgroup analyses showed consistent results for 1 vs. 3 month DAPT and for aspirin vs. P2Y12 inhibitor monotherapy following very short DAPT.

CONCLUSIONS: Compared with long DAPT, very short DAPT did not increase the odds of ischaemic complications, while reducing the odds of major or any bleeding by over 30%.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: [email protected].

Keywords: Acute coronary syndrome; Drug-eluting stent; Dual antiplatelet therapy; Long term; Very short

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