Short duration of dual antiplatelet therapy following complex percutaneous coronary intervention: A systematic review and meta-analysis

Authors

Mohamed Magdi Eid, Rochester Regional HealthFollow
Mostafa Reda Mostafa, Rochester Regional HealthFollow
Ahmad Alabdouh, Department of Medicine, University of Kentucky, Lexington, KY, USA.
Mostafa Najim, Rochester Regional HealthFollow
Sarah Mohamed, Faculty of Medicine, Cairo University, Cairo, Egypt.
Abdul Rahman Ziada, Tanta University School of Medicine, Tanta, Egypt.
Andrew Takla, Rochester Regional HealthFollow
Mallory Balmer-Swain, Rochester Regional HealthFollow
Bipul Baibhav, Rochester Regional HealthFollow
Karim M. Al-Azizi, Interventional Cardiology and Structural Heart Disease, Baylor Scott & White Health-The Heart Hospital Plano, USA.
Andrew M. Goldsweig, Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, USA; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA.

Department

Internal Medicine

Additional Department

Cardiology

Document Type

Article

Publication Title

Cardiovascular Revascularization Medicine : Including Molecular Interventions

Abstract

Introduction and aim: The optimal composition and duration of antiplatelet therapy after complex percutaneous coronary intervention (PCI) remains unclear. We conducted a meta-analysis to compare 1-3 months of dual antiplatelet therapy (DAPT) followed by monotherapy vs. 12 months of DAPT.

Method: MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for studies comparing 1-3 months of DAPT followed by monotherapy vs. 12 months of DAPT in the outcomes of complex PCI from inception through January 2023. Outcomes of interest included major bleeding, all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stent thrombosis, target vessel revascularization, and stroke.

Results: Compared to 12 months, 1-3 months of dual antiplatelet therapy had a weak association with less major bleeding (OR 0.67; 95 % CI, 0.44-1.00; p = 0.05; I² = 28 %). There were no significant differences between the shorter and longer antiplatelet therapy in terms of all-cause mortality (OR 0.83; 95 % CI, 0.59-1.16; p = 0.21; I² = 17 %), cardiovascular mortality (OR 0.87; 95 % CI, 0.53-0.42; p = 0.50; I² = 0), MI (OR 0.97; 95 % CI, 0.69-1.35; p = 0.82; I² = 32 %), stent thrombosis (OR 1.17, 95 % CI, 0.77-1.76; p = 0.38; I² = 0 %), target vessel revascularization (OR 1.05, 95 % CI, 0.58-1.89; p = 0.82; I² = 64 %), or stroke (OR 1.10, 95 % CI, 0.55-2.17; p = 0.37; I² = 7 %);.

Conclusion: Among patients undergoing complex PCI, DAPT for 1-3 months may be associated with less major bleeding but similar rates of cardiovascular events (death, MI, stroke, stent thrombosis, and revascularization) compared to DAPT for 12 months.

First Page

8

Last Page

15

DOI

10.1016/j.carrev.2023.11.002

Volume

61

Publication Date

4-1-2024

Medical Subject Headings

Humans; Platelet Aggregation Inhibitors (adverse effects); Percutaneous Coronary Intervention (adverse effects); Drug-Eluting Stents (adverse effects); Myocardial Infarction; Hemorrhage (chemically induced); Thrombosis (etiology); Stroke (etiology); Drug Therapy, Combination; Treatment Outcome

PubMed ID

37951758

Recommended Citation

Eid, M. M., Reda Mostafa, M., Alabdouh, A., Najim, M., Mohamed, S., Ziada, A. R., Takla, A., Balmer-Swain, M., Baibhav, B., Al-Azizi, K. M., & Goldsweig, A. M. (2024). Short duration of dual antiplatelet therapy following complex percutaneous coronary intervention: A systematic review and meta-analysis. Cardiovascular Revascularization Medicine : Including Molecular Interventions, 61, 8-15. https://doi.org/10.1016/j.carrev.2023.11.002