Short dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk patients: Systematic review and meta-analysis

Dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) reduces major adverse cardiovascular events (MACE) and stent thrombosis. However, DAPT duration is a concern in high bleeding risk (HBR) patients. We evaluated the effect of short DAPT (1-3 months) compared to standa...

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Bibliographic Details
Published in:PloS one Vol. 18; no. 9; p. e0291061
Main Authors: Bainey, Kevin R., Marquis-Gravel, Guillaume, MacDonald, Blair J., Bewick, David, Yan, Andrew, Turgeon, Ricky D.
Format: Journal Article
Language:English
Published: San Francisco Public Library of Science 01.09.2023
Public Library of Science (PLoS)
Subjects:
Acute coronary syndromes
Aggregation
Angioplasty
Anticoagulants
Antiplatelet therapy
Bias
Bleeding
Blood clot
Blood platelets
Cardiovascular diseases
Care and treatment
Clinical trials
Confidence intervals
Consortia
Health risks
Heart attacks
Implants
Intervention
Ischemia
Medicine and Health Sciences
Meta-analysis
Mortality
Patient outcomes
Physical Sciences
Prevention
Research and Analysis Methods
Risk assessment
Stents
Systematic review
Thromboembolism
Thrombosis
Canada
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) reduces major adverse cardiovascular events (MACE) and stent thrombosis. However, DAPT duration is a concern in high bleeding risk (HBR) patients. We evaluated the effect of short DAPT (1-3 months) compared to standard DAPT (6-12 months) on bleeding and ischemic events in HBR PCI. We searched MEDLINE, Embase and CENTRAL up to August 18, 2022. Randomized controlled trials (RCTs) comparing short DAPT (1-3 months) versus standard DAPT in HBR PCI were included. We assessed risk of bias (RoB) using the Cochrane RoB2 tool, and certainty of evidence using GRADE criteria. Outcomes included MACE, all-cause death, stent thrombosis, major bleeding, and the composite of major or clinically-relevant non-major bleeding. We estimated risk ratios (RR) and 95% confidence intervals (CI) using a random-effects model. From 503 articles, we included five RCTs (n = 7,242) at overall low risk of bias with median follow-up of 12-months. Compared to standard DAPT, short DAPT did not increase MACE (RR 1.02, 95% CI 0.84-1.23), all-cause death (RR 0.92, 95% CI 0.71-1.20) or stent thrombosis (RR 1.47, 95% CI 0.73-2.93). Short DAPT reduced major bleeding (RR 0.34, 95% CI 0.13-0.90) and the composite of major or clinically-relevant non-major bleeding (RR 0.60, 95% CI 0.44-0.81), translating to 21 and 34 fewer events, respectively, per 1000 patients. In HBR PCI, DAPT for 1-3 months compared to 6-12 months reduced clinically-relevant bleeding events without jeopardizing ischemic risk. Short DAPT should be considered in HBR patients receiving PCI.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0291061