Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Sep 1;18(9):e0291061.
doi: 10.1371/journal.pone.0291061. eCollection 2023.

Short dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk patients: Systematic review and meta-analysis

Kevin R Bainey  1 , Guillaume Marquis-Gravel  2 , Blair J MacDonald  3 , David Bewick  4 , Andrew Yan  5 , Ricky D Turgeon  3
Affiliations
Meta-Analysis

Short dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk patients: Systematic review and meta-analysis

Kevin R Bainey et al. PLoS One. .

Abstract

Introduction: Dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) reduces major adverse cardiovascular events (MACE) and stent thrombosis. However, DAPT duration is a concern in high bleeding risk (HBR) patients. We evaluated the effect of short DAPT (1-3 months) compared to standard DAPT (6-12 months) on bleeding and ischemic events in HBR PCI.

Methods: We searched MEDLINE, Embase and CENTRAL up to August 18, 2022. Randomized controlled trials (RCTs) comparing short DAPT (1-3 months) versus standard DAPT in HBR PCI were included. We assessed risk of bias (RoB) using the Cochrane RoB2 tool, and certainty of evidence using GRADE criteria. Outcomes included MACE, all-cause death, stent thrombosis, major bleeding, and the composite of major or clinically-relevant non-major bleeding. We estimated risk ratios (RR) and 95% confidence intervals (CI) using a random-effects model.

Results: From 503 articles, we included five RCTs (n = 7,242) at overall low risk of bias with median follow-up of 12-months. Compared to standard DAPT, short DAPT did not increase MACE (RR 1.02, 95% CI 0.84-1.23), all-cause death (RR 0.92, 95% CI 0.71-1.20) or stent thrombosis (RR 1.47, 95% CI 0.73-2.93). Short DAPT reduced major bleeding (RR 0.34, 95% CI 0.13-0.90) and the composite of major or clinically-relevant non-major bleeding (RR 0.60, 95% CI 0.44-0.81), translating to 21 and 34 fewer events, respectively, per 1000 patients.

Conclusions: In HBR PCI, DAPT for 1-3 months compared to 6-12 months reduced clinically-relevant bleeding events without jeopardizing ischemic risk. Short DAPT should be considered in HBR patients receiving PCI.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Fig 2
Fig 2
Forest plot of major adverse cardiovascular events (A), all-cause mortality (B) and stent thrombosis (C) with short dual antiplatelet therapy or standard dual antiplatelet therapy in patients with high bleeding risk receiving percutaneous coronary intervention. Squares and diamonds = risk ratios. Lines = 95% confidence intervals.
Fig 3
Fig 3
Forest plot of major bleeding (A) and major or clinically-relevant non-major bleeding (B) with short dual antiplatelet therapy or standard dual antiplatelet therapy in patients with high bleeding risk receiving percutaneous coronary intervention. Squares and diamonds = risk ratios. Lines = 95% confidence intervals.
Fig 4
Fig 4. Central illustration.
HBR: High bleeding risk; DAPT: Dual antiplatelet therapy.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Mehta SR, Bainey KR, Cantor WJ, Lordkipanidzé M, Marquis-Gravel G, Robinson SD, et al.. 2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy. Canadian Journal of Cardiology. 2018;34. doi: 10.1016/j.cjca.2017.12.012 - DOI - PubMed
    1. Costa F, van Klaveren D, James S, Heg D, Räber L, Feres F, et al.. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. The Lancet. 2017;389: 1025–1034. doi: 10.1016/S0140-6736(17)30397-5 - DOI - PubMed
    1. Windecker S, Latib A, Kedhi E, Kirtane AJ, Kandzari DE, Mehran R, et al.. Polymer-based or Polymer-free Stents in Patients at High Bleeding Risk. New England Journal of Medicine. 2020;382: 1208–1218. doi: 10.1056/NEJMoa1910021 - DOI - PubMed
    1. Valgimigli M, Cao D, Angiolillo DJ, Bangalore S, Bhatt DL, Ge J, et al.. Duration of Dual Antiplatelet Therapy for Patients at High Bleeding Risk Undergoing PCI. Journal of the American College of Cardiology. 2021;78: 2060–2072. doi: 10.1016/j.jacc.2021.08.074 - DOI - PubMed
    1. Hahn JY, Song Y Bin, Oh JH, Chun WJ, Park YH, Jang WJ, et al.. Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention: The SMART-CHOICE Randomized Clinical Trial. JAMA. 2019;321: 2428–2437. doi: 10.1001/jama.2019.8146 - DOI - PMC - PubMed

Publication types

Substances