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Meta-Analysis
. 2022 Oct 28;22(1):450.
doi: 10.1186/s12872-022-02900-6.

Safety and efficacy of interrupting dual antiplatelet therapy one month following percutaneous coronary intervention: a meta-analysis of randomized controlled trials

Shane Parfrey  1 , Amr Abdelrahman  1 , Daniel Blackman  1   2 , Jonathan M Blaxill  1   2 , Michael S Cunnington  1 , John P Greenwood  1   2 , Christopher J Malkin  1   2 , Abdul M Mozid  1   2 , Jennifer A Rossington  1   2 , Murugapathy Veerasamy  1   2 , Nancy Wassef  1 , Stephen B Wheatcroft  1   2 , Heerajnarain Bulluck  3   4
Affiliations
Meta-Analysis

Safety and efficacy of interrupting dual antiplatelet therapy one month following percutaneous coronary intervention: a meta-analysis of randomized controlled trials

Shane Parfrey et al. BMC Cardiovasc Disord. .

Abstract

Very short duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) has recently attracted a lot of attention with the introduction of newer generations stents. This is appealing, especially in patients at high bleeding risk. However, none of the trials were powered for the individual ischemic and bleeding endpoints. All randomised controlled trials (RCTs) investigating one-month versus routine duration of DAPT in patients undergoing PCI and reporting outcomes from the time of cessation of DAPT (1 month) to 1 year were eligible for inclusion in the meta-analysis. The pooled risk ratios (RR) with their 95% confidence interval (CI) were calculated with the random-effects model using the Mantel-Haenszel method. Four RCTs involving 26,576 patients were included in this meta-analysis. Cessation of DAPT after 1 month was associated with significantly less major bleeding [RR 0.70, 95%CI (0.51-0.95), P = 0.02, heterogeneity (I2) = 42%]. There was no statistically significant difference in all-cause mortality [RR 0.84 (95%CI 0.69-1.03), P = 0.10, I2 = 0%] and stroke [RR 0.71 (95%CI 0.45-1.13), P = 0.15, I2 = 42%] when compared to routine duration of DAPT. There was also no difference in myocardial infarction (MI) [RR 1.12 (95%CI 0.91-1.39), P = 0.28, I2 = 0%], and definite or probable stent thrombosis [RR 1.49 (95%CI 0.92-2.41), P = 0.11, I2 = 0%] with cessation of DAPT after 1 month. Cessation of DAPT 1 month after PCI was associated with significantly less major bleeding, but there was no difference in the rate of all-cause mortality, stroke, MI and stent thrombosis.

Keywords: Dual antiplatelet therapy; Major bleeding; Mortality; Myocardial infarction; Percutaneous coronary intervention, one-month; Randomized controlled trials; Stent thrombosis; Stroke.

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Conflict of interest statement

None of the authors have any competing interests related to this work.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the search for published trials showing search strategy with excluded studies and reason for exclusion
Fig. 2
Fig. 2
Forest plots comparing one-month DAPT to routine DAPT for major bleeding
Fig. 3
Fig. 3
Forest plot comparing one-month DAPT to routine DAPT for (a) all-cause mortality and (b) stroke
Fig. 4
Fig. 4
Forest plot comparing one-month DAPT to routine DAPT for (a) myocardial infarction and (b) stent thrombosis
See this image and copyright information in PMC

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