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Meta-Analysis
. 2015 Apr 16:350:h1618.
doi: 10.1136/bmj.h1618.

Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials

Eliano Pio Navarese  1 , Felicita Andreotti  2 , Volker Schulze  3 , Michalina Kołodziejczak  4 , Antonino Buffon  5 , Marc Brouwer  6 , Francesco Costa  7 , Mariusz Kowalewski  8 , Gianfranco Parati  9 , Gregory Y H Lip  10 , Malte Kelm  3 , Marco Valgimigli  7
Affiliations
Meta-Analysis

Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials

Eliano Pio Navarese et al. BMJ. .

Erratum in

Abstract

Objective: To assess the benefits and risks of short term (<12 months) or extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12 month therapy, following percutaneous coronary intervention with drug eluting stents.

Design: Meta-analysis of randomised controlled trials.

Data sources: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library, and major congress proceedings, searched from 1 January 2002 to 16 February 2015.

Review methods: Trials comparing short term (<12 months) or extended (>12 months) DAPT regimens with standard 12 month duration of therapy. Primary outcomes were cardiovascular mortality, myocardial infarction, stent thrombosis, major bleeding, and all cause mortality.

Results: 10 randomised controlled trials (n=32,287) were included. Compared to 12 month DAPT, a short term course of therapy was associated with a significant reduction in major bleeding (odds ratio 0.58 (95% confidence interval 0.36 to 0.92); P=0.02) with no significant differences in ischaemic or thrombotic outcomes. Extended versus 12 month DAPT yielded a significant reduction in the odds of myocardial infarction (0.53 (0.42 to 0.66); P<0.001) and stent thrombosis (0.33 (0.21 to 0.51); P<0.001), but more major bleeding (1.62 (1.26 to 2.09); P<0.001). All cause but not cardiovascular death was also significantly increased (1.30 (1.02 to 1.66); P=0.03).

Conclusions: Compared with a standard 12 month duration, short term DAPT (<12 months) after drug eluting stent implementation yields reduced bleeding with no apparent increase in ischaemic complications, and could be considered for most patients. In selected patients with low bleeding risk and very high ischaemic risk, extended DAPT (>12 months) could be considered. The increase in all cause but not cardiovascular death with extended DAPT requires further investigation.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that EPN has received honorariums for lectures from Eli Lilly; MV has received fees for lecturing from or has served on the advisory board of Abbott Vascular, Alvimedica, AstraZeneca, Correvio, The Medicines Company, Medtronic, and Terumo; FA has received honorariums for lectures and advisory boards from Amgen, Bayer, Boehringer Ingelheim, BMS-Pfizer, and Daiichi Sankyo-Eli Lilly; all the remaining authors do not have any conflicts relevant to this contribution.

Figures

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Fig 1 Individual and summary odds ratios for the endpoints of cardiovascular mortality and myocardial infarction. M-H=Mantel-Haenszel. Data stratified by duration of dual antiplatelet therapy: short term (<12 months) versus 12 months, and extended (>12 months) versus 12 months
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Fig 2 Individual and summary odds ratios for the endpoints of definite/probable stent thrombosis and definite stent thrombosis, and analysis of late and very late stent thrombosis. Data stratified by duration of dual antiplatelet therapy: short term (<12 months) versus 12 months, and extended (>12 months) versus 12 months
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Fig 3 Individual and summary odds ratios for the endpoint of major bleeding. Data stratified by duration of dual antiplatelet therapy: short term (<12 months) versus 12 months, and extended (>12 months) versus 12 months
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Fig 4 Individual and summary odds ratios for the endpoint of all cause mortality. Data stratified by duration of dual antiplatelet therapy: short term (<12 months) versus 12 months, and extended (>12 months) versus 12 months
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Fig 5 Individual and summary odds ratios for the endpoint of repeat revascularisation. Data stratified by duration of dual antiplatelet therapy: short term (<12 months) versus 12 months, and extended (>12 months) versus 12 months
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References

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