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Review
. 2019 Feb 11;9(1):9-17.
doi: 10.1080/20009666.2018.1562853. eCollection 2019.

Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials

Mahmoud Barbarawi  1 , Babikir Kheiri  1 , Yazan Zayed  1 , Ahmed Aburahma  1 , Mohammed Osman  1 , Owais Barbarawi  2 , Michael Hicks  1 , Mustafa Hassan  3 , Mohammad L Alkotob  3 , Ghassan Bachuwa  1
Affiliations
Review

Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials

Mahmoud Barbarawi et al. J Community Hosp Intern Med Perspect. .

Abstract

Background: Drug-eluting stent(DES) implantation is the main interventional treatment for coronary artery disease, and dual antiplatelet therapy(DAPT) remains the gold standard strategy to prevent ischemic events. However, the optimal duration of DAPT after DES implantation remains controversial. Therefore, we aimed to evaluate the best duration of DAPT following DES implantation. Method: We searched PubMed, Embase, Cochrane Library, and clinicaltrials.gov for all randomized clinical trials(RCTs) that compared different durations of DAPT after DES implantation. Major adverse cardiac events(MACE) and major bleeding were the primary and secondary outcomes, respectively. Results: We included 16 RCTs (n = 42,993). The mean age of included patients was 63.1 ± 10.1. The primary outcome was statistically significant for lower MACE in patients who received DAPT for 24-48 months (mo) following DES when compared with those who received 3-6 mo of DAPT (odds ratio [OR] 0.75; 95% credible interval [CI] 0.58-0.97). There was nonstatistically significant difference in MACE when comparing those who received 12 mo of DAPT to those taking either 3-6 mo of DAPT (OR 0.86; 95% CI 0.69-1.08) or 24-48 mo of DAPT (OR 0.87; 95% CI 0.72-1.05). In contrast, major bleeding was significantly lower in those who received 3-6 mo of DAPT (OR 0.32; 95% CI 0.17-0.54) and 12 mo of DAPT (OR 0.43; 95% CI 0.27-0.63) than in those who received 24-48 mo of DAPT. Conclusion: In patients who undergo DES implantation, a longer duration of DAPT is associated with lower MACE, despite the increased risk of major bleeding events. Therefore, individualizing the duration of DAPT after DES according to the patient's risk of bleeding and recurrent ischemia is recommended.

Keywords: Dual antiplatelet; antiplatelet duration; aspirin; clopidogrel; drug eluting stent; meta-analysis.

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Figures

Figure 1.
Figure 1.
Preferred reporting items for systematic reviews and meta-analyses chart of the studies selection process.
Figure 2.
Figure 2.
Forest plots summarizing the major adverse cardiac events between the competing treatments duration. Random effects model was used to report the odds ratios (ORs) with 95% credible intervals (CIs).
Figure 3.
Figure 3.
Forest plots summarizing the major bleeding events between the competing treatments duration. Random effects model was used to report the odds ratios (ORs) with 95% credible intervals (CIs).
See this image and copyright information in PMC

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