The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is under controversial. The aim of the present systematic review and meta-analysis was to evaluate the safety and efficacy of short-term (≤6 months) DAPT versus long-term (≥12 months) DAPT after PCI with a drug-eluting stent (DES).
We systematically searched the Cochrane Library, PubMed and Embase databases to identify randomized controlled trials (RCTs) that compared short-term (≤6 months) and long-term (≥12 months) DAPT. The endpoints included major bleeding, any bleeding, death from any cause, cardiac death, myocardial infarction, stroke, stent thrombosis, and target vessel revascularization. The primary outcome was major bleeding. A fixed-effects model was used to calculate the risk ratio (RR) and 95% confidence interval (CI) of each endpoint.
Eighteen trials involving 57,940 patients were included. Compared with long-term DAPT, short-term DAPT resulted in lower rates of major bleeding [RR 0.75, 95% CI 0.65-0.87, p=0.0002] and any bleeding [RR 0.61, 95% CI 0.54-0.69, p<0.00001]. No significant difference was observed in the outcomes of death from any cause, cardiac death, myocardial infarction, stroke, stent thrombosis, or target vessel revascularization. The subgroup analysis according to different DAPT durations, mono antiplatelet therapies (MAPTs), countries and P2Y12 inhibitors produced similar outcomes as comprehensive outcomes.
Compared to long-term DAPT, short-term DAPT did not increase the risk of ischemic complications but did reduce the risks of major bleeding and any bleeding by over 25%. This study showed that short-term DAPT could be considered for most patients after DES implantation.
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