Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials

Francesco Costa, Claudio Montalto, Mattia Branca, Sung Jin Hong, Hirotoshi Watanabe, Anna Franzone, Pascal Vranckx, Joo Yong Hahn, Hyeon Cheol Gwon, Fausto Feres, Yangsoo Jang, Giuseppe De Luca, Elvin Kedhi, Davide Cao, Philippe Gabriel Steg, Deepak L. Bhatt, Gregg W. Stone, Antonio Micari, Stephan Windecker, Takeshi KimuraMyeong Ki Hong, Roxana Mehran, Marco Valgimigli

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Aims The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) is still debated. The current study, using the totality of existing evidence, evaluated the impact of an abbreviated DAPT regimen in HBR patients. Methods and results A systematic review and meta-analysis was performed to search randomized clinical trials comparing abbreviated [i.e. very-short (1 month) or short (3 months)] with standard (≥6 months) DAPT in HBR patients without indication for oral anticoagulation. A total of 11 trials, including 9006 HBR patients, were included. Abbreviated DAPT reduced major or clinically relevant non-major bleeding [risk ratio (RR): 0.76, 95% confidence interval (CI): 0.61–0.94; I2 = 28%], major bleeding (RR: 0.80, 95% CI: 0.64–0.99, I2 = 0%), and cardiovascular mortality (RR: 0.79, 95% CI: 0.65–0.95, I2 = 0%) compared with standard DAPT. No difference in all-cause mortality, major adverse cardiovascular events, myocardial infarction, or stent thrombosis was observed. Results were consistent, irrespective of HBR definition and clinical presentation. Conclusion In HBR patients undergoing PCI, a 1- or 3-month abbreviated DAPT regimen was associated with lower bleeding and cardiovascular mortality, without increasing ischaemic events, compared with a ≥6-month DAPT regimen.

Original languageEnglish
Pages (from-to)954-968
Number of pages15
JournalEuropean Heart Journal
Volume44
Issue number11
DOIs
StatePublished - 14 Mar 2023

Keywords

  • Aspirin
  • Dual antiplatelet therapy
  • High bleeding risk
  • Monotherapy
  • P2Y12 inhibitor
  • Percutaneous coronary intervention

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