Short dual antiplatelet therapy in patients with high bleeding risk undergoing percutaneous coronary intervention: a systematic review and meta-analysis.

Zhang, Junyan, Chen, Zhongxiu, Li, Chen, Wang, Duolao ORCID: https://orcid.org/0000-0003-2788-2464, He, Siyu, Luo, Chaoyu, Luo, Fangbo and He, Yong (2022) 'Short dual antiplatelet therapy in patients with high bleeding risk undergoing percutaneous coronary intervention: a systematic review and meta-analysis.'. Coronary Artery Disease, Vol 33, Issue 7, pp. 580-589.

Text Coronary artery disease-Short dual antiplatelet therapy in patients with high bleeding risk undergoing percutaneous coronary intervention.pdf - Accepted Version Restricted to Repository staff only until 1 November 2023. Download (746kB)

Abstract

Background

The efficacy and safety of an abbreviated duration of dual antiplatelet therapy (DAPT) in patients with high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) (PCI-HBR patients) remain controversial.

Methods

The Cochrane Library, PubMed, EMBASE, and Ovid MEDLINE databases were searched. Studies that enrolled PCI-HBR patients as research subjects, compared different DAPT durations, and reported incidences of major adverse cardiac events (MACE) and net adverse clinical events (NACE) in PCI-HBR patients were obtained. The studies were stratified according to the DAPT duration (1, 3, and 6 months), and meta-analysis was subsequently performed.

Results

Nine studies (10 cohorts) were included in the meta-analysis. Compared with those who received DAPT for >1 month, PCI-HBR patients who received the 1-month DAPT regimen had comparable risks of NACE and MACE. Compared to those who received DAPT for >3 months, the risk of developing MACE in PCI-HBR patients who received the 3-month DAPT was not increased; however, the risk of ischemic stroke and stent thrombosis increased. Compared to those who received DAPT for >6 months, patients who received the 6-month DAPT had a reduction in the risk of major bleeding without an increase in NACE and MACE.

Conclusions

Shortening the DAPT regimen to 1 or 6 months did not increase the risk of MACE, and the 6-month DAPT regimen reduced the risk of major bleeding. However, the 3-month DAPT regimen increased the risk of ischemic stroke. Thus, shortened DAPT reduced the risk of MACE and bleeding, with a small absolute increase in ischemic strokes.

Item Type:	Article
Subjects:	WG Cardiovascular System > Heart. Heart Diseases > WG 200 General works WH Hemic and Lymphatic Systems > WH 20 Research (General)
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1097/MCA.0000000000001180
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	13 Dec 2022 10:44
Last Modified:	21 Jun 2023 12:05
URI:	https://archive.lstmed.ac.uk/id/eprint/21314

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