Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials
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. Th...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Greater Baltimore Medical Center
2019-01-01
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| Series: | Journal of Community Hospital Internal Medicine Perspectives |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/20009666.2018.1562853 |
| _version_ | 1797964849306664960 |
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| author | Mahmoud Barbarawi Babikir Kheiri Yazan Zayed Ahmed Aburahma Mohammed Osman Owais Barbarawi Michael Hicks Mustafa Hassan Mohammad L. Alkotob Ghassan Bachuwa |
| author_facet | Mahmoud Barbarawi Babikir Kheiri Yazan Zayed Ahmed Aburahma Mohammed Osman Owais Barbarawi Michael Hicks Mustafa Hassan Mohammad L. Alkotob Ghassan Bachuwa |
| author_sort | Mahmoud Barbarawi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T01:51:17Z |
| format | Article |
| id | doaj.art-be6c817f74ab45b3824db4427bfa45eb |
| institution | Directory Open Access Journal |
| issn | 2000-9666 |
| language | English |
| last_indexed | 2024-04-11T01:51:17Z |
| publishDate | 2019-01-01 |
| publisher | Greater Baltimore Medical Center |
| record_format | Article |
| series | Journal of Community Hospital Internal Medicine Perspectives |
| spelling | doaj.art-be6c817f74ab45b3824db4427bfa45eb2023-01-03T06:27:06ZengGreater Baltimore Medical CenterJournal of Community Hospital Internal Medicine Perspectives2000-96662019-01-019191710.1080/20009666.2018.15628531562853Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trialsMahmoud Barbarawi0Babikir Kheiri1Yazan Zayed2Ahmed Aburahma3Mohammed Osman4Owais Barbarawi5Michael Hicks6Mustafa Hassan7Mohammad L. Alkotob8Ghassan Bachuwa9Hurley Medical Center/Michigan State UniversityHurley Medical Center/Michigan State UniversityHurley Medical Center/Michigan State UniversityHurley Medical Center/Michigan State UniversityHurley Medical Center/Michigan State UniversityMutah UniversityHurley Medical Center/Michigan State UniversityHurley Medical Center/Michigan State UniversityHurley Medical Center/Michigan State UniversityHurley Medical Center/Michigan State UniversityBackground: 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.http://dx.doi.org/10.1080/20009666.2018.1562853Dual antiplateletdrug eluting stentaspirinclopidogrelantiplatelet durationmeta-analysis |
| spellingShingle | Mahmoud Barbarawi Babikir Kheiri Yazan Zayed Ahmed Aburahma Mohammed Osman Owais Barbarawi Michael Hicks Mustafa Hassan Mohammad L. Alkotob Ghassan Bachuwa Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials Journal of Community Hospital Internal Medicine Perspectives Dual antiplatelet drug eluting stent aspirin clopidogrel antiplatelet duration meta-analysis |
| title | Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials |
| title_full | Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials |
| title_fullStr | Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials |
| title_full_unstemmed | Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials |
| title_short | Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials |
| title_sort | best duration of dual antiplatelet therapy after drug eluting stent implantation an updated network meta analysis of randomized controlled trials |
| topic | Dual antiplatelet drug eluting stent aspirin clopidogrel antiplatelet duration meta-analysis |
| url | http://dx.doi.org/10.1080/20009666.2018.1562853 |
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