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Review
. 2017 Sep 20;12(9):e0174502.
doi: 10.1371/journal.pone.0174502. eCollection 2017.

Short versus prolonged dual antiplatelet therapy (DAPT) duration after coronary stent implantation: A comparison between the DAPT study and 9 other trials evaluating DAPT duration

Toshiaki Toyota  1 , Hiroki Shiomi  1 , Takeshi Morimoto  2 , Masahiro Natsuaki  3 , Takeshi Kimura  1
Affiliations
Review

Short versus prolonged dual antiplatelet therapy (DAPT) duration after coronary stent implantation: A comparison between the DAPT study and 9 other trials evaluating DAPT duration

Toshiaki Toyota et al. PLoS One. .

Abstract

Aims: The Dual Antiplatelet Therapy (DAPT) study demonstrated that DAPT beyond 1-year after drug-eluting stent (DES) implantation, as compared with aspirin therapy alone, significantly reduced the risk of major cardiovascular and cerebrovascular events, which was mainly driven by the large risk reduction for myocardial infarction (MI). We sought to compare the largest DAPT study with other trials evaluating DAPT durations after DES implantation.

Methods and results: By a systematic literature search, we identified 9 trials comparing prolonged- versus short-DAPT in addition to the DAPT study. The result from the DAPT study (N = 9961) with public-private collaboration was different from the pooled result of the 9 other investigator-driven trials (N = 22174) in terms of the effect of prolonged-DAPT on MI (odds ratio [OR] 0.48 [95%CI 0.38-0.62] versus pooled OR 0.88 [95%CI 0.67-1.15]: P = 0.001 for difference), while the trends for excess risk of prolonged-DAPT relative to short-DAPT for all-cause death (OR 1.31 [95%CI 0.97-1.78] versus pooled OR 1.16 [95%CI 0.92-1.45]: P = 0.53 for difference), and bleeding (OR 1.62 [95%CI 1.21-2.17] versus pooled OR 2.08 [95%CI 1.51-2.84]: P = 0.25 for difference) were consistently seen in both the DAPT and other trials. The annual rate of MI during aspirin mono-therapy in the DAPT study was much higher than that those in the other trials (2.7% versus 0.6-1.6%).

Conclusions: Given the difference between the DAPT study and other trials, future studies should focus on certain subgroups of patients that are more or less likely to benefit from longer duration DAPT.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Forest plot with OR of prolonged-DAPT relative to short-DAPT for each clinical outcome for the DAPT trial and the pooled population excluding the DAPT trial.
ORs are shown on a logarithmic scale. CI = confidence interval, DAPT = dual anti-platelet therapy, and OR = odds ratio.
Fig 2
Fig 2. Estimated annual event rates for myocardial infarction and stent thrombosis in the short-DAPT group during aspirin mono-therapy.
The landmark data was not available for myocardial infarction in the RESET and EXCELLENT trials. NA = not available.
See this image and copyright information in PMC

Comment in

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