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2016 ; 87
(4
): 722-732
Nephropedia Template TP
gab.com Text
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English Wikipedia
Safety of an abbreviated duration of dual antiplatelet therapy (?6 months)
following second-generation drug-eluting stents for coronary artery disease: A
systematic review and meta-analysis of randomized trials
#MMPMID26309050
Ziada KM
; Abdel-Latif AK
; Charnigo R
; Moliterno DJ
Catheter Cardiovasc Interv
2016[Mar]; 87
(4
): 722-732
PMID26309050
show ga
BACKGROUND: Dual antiplatelet therapy (DAPT) is recommended for ?12 months
following coronary drug-eluting stents (DES) to reduce risk of major adverse
ischemic events. Randomized trials suggest an abbreviated DAPT duration (?6
months) is adequately protective. However, these trials are individually
underpowered to detect differences in rare but serious events such as stent
thrombosis (ST). OBJECTIVES: We performed a meta-analysis of published randomized
trials to define the impact of abbreviated DAPT (?6 months) on death, myocardial
infarction (MI), stent thrombosis (ST), and bleeding complications compared to
standard-duration DAPT (?12 months). METHODS: Seven randomized controlled trials
comparing abbreviated vs. standard DAPT regimens following DES use were
identified by two independent investigators. Study characteristics were reviewed
and clinical endpoint data were abstracted and analyzed in aggregate using fixed
and random-effects models. RESULTS: The seven trials included 15,874 randomized
patients. Second-generation DES were used in most patients. Compared to
standard-duration DAPT, abbreviated DAPT was not associated with an increase in
mortality (OR 0.93; CI: 0.73 to 1.17; P?=?0.52), MI (OR 1.14; CI: 0.89 to 1.45;
P?=?0.30) or ST (OR 1.25; CI: 0.81 to 1.93; P?=?0.31). Abbreviated DAPT was
associated with significantly fewer major bleeding complications (OR 0.52; CI:
0.34 to 0.82; P?=?0.005). The results were consistent between fixed and
random-effects models, with no heterogeneity. Sensitivity analyses adjusting for
inclusion of bare metal stents, 1st generation DES and/or abbreviated DAPT
regimens of 3 months resulted in similar conclusions. CONCLUSIONS: In a
meta-analysis of >15,000 patients primarily treated with second-generation DES,
abbreviated-duration DAPT (?6 months) was associated with a significant reduction
in major bleeding complications with no evidence of a significant increase in
risk of death, MI or ST. Accordingly, abbreviated DAPT should be strongly
considered for patients receiving second generation DES.