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Article: Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: Meta-analysis of randomized controlled trials

TitleOptimal duration of dual antiplatelet therapy after drug-eluting stent implantation: Meta-analysis of randomized controlled trials
Authors
Issue Date2016
PublisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ijcard
Citation
International Journal of Cardiology, 2016, v. 220, p. 895-900 How to Cite?
AbstractObjective After implantation of drug-eluting stents (DES), patients usually receive 6–12 months of dual antiplatelet therapy (DAPT). However, the optimal duration of DAPT is controversial. Therefore, we performed a meta-analysis of randomized controlled trials to assess the risks and benefits of different DAPT durations. Methods We searched the literature using MEDLINE, Scopus, EMBASE, ISI Web of Science, Cochrane Library, ClinicalTrials.gov and recent conference proceedings, and included those trials randomizing patients to receive different durations of DAPT after DES implantation and reporting frequencies of cardiovascular and bleeding events. Data from eleven trials were analyzed using RevMan. Results Compared to 12-month DAPT treatment, extended DAPT significantly reduced the frequencies of myocardial infarction (OR 0.54 95% CI: 0.43–0.66; p < 0.00001) and stent thrombosis (OR 0.36 95% CI: 0.24–0.55; p < 0.00001), but the risks of major bleeding (OR 1.54 95% CI 1.22–1.96) and all-cause mortality (OR 1.43 95% CI 1.14–1.81) were substantially increased. There was no significant difference in stroke, cardiovascular mortality or repeat revascularization. Compared to short-term DAPT, 12-month DAPT or longer was associated with increased major bleeds (OR 1.98 95% CI: 1.26–3.11). No significant differences were found in the risk of other primary outcomes. Conclusion 12-month DAPT appears to be a pragmatic compromise between preventing stent thrombosis and increasing bleeding risk. Patients at high bleeding risk should have shorter duration DAPT while those with low bleeding risk can be considered for DAPT beyond 12 months. © 2016 Elsevier Ireland Ltd.
Persistent Identifierhttp://hdl.handle.net/10722/232038
ISSN
2015 Impact Factor: 4.638
2015 SCImago Journal Rankings: 1.513

 

DC FieldValueLanguage
dc.contributor.authorFei, Y-
dc.contributor.authorTsoi, MF-
dc.contributor.authorCheung, TT-
dc.contributor.authorCheung, BMY-
dc.date.accessioned2016-09-20T05:27:12Z-
dc.date.available2016-09-20T05:27:12Z-
dc.date.issued2016-
dc.identifier.citationInternational Journal of Cardiology, 2016, v. 220, p. 895-900-
dc.identifier.issn0167-5273-
dc.identifier.urihttp://hdl.handle.net/10722/232038-
dc.description.abstractObjective After implantation of drug-eluting stents (DES), patients usually receive 6–12 months of dual antiplatelet therapy (DAPT). However, the optimal duration of DAPT is controversial. Therefore, we performed a meta-analysis of randomized controlled trials to assess the risks and benefits of different DAPT durations. Methods We searched the literature using MEDLINE, Scopus, EMBASE, ISI Web of Science, Cochrane Library, ClinicalTrials.gov and recent conference proceedings, and included those trials randomizing patients to receive different durations of DAPT after DES implantation and reporting frequencies of cardiovascular and bleeding events. Data from eleven trials were analyzed using RevMan. Results Compared to 12-month DAPT treatment, extended DAPT significantly reduced the frequencies of myocardial infarction (OR 0.54 95% CI: 0.43–0.66; p < 0.00001) and stent thrombosis (OR 0.36 95% CI: 0.24–0.55; p < 0.00001), but the risks of major bleeding (OR 1.54 95% CI 1.22–1.96) and all-cause mortality (OR 1.43 95% CI 1.14–1.81) were substantially increased. There was no significant difference in stroke, cardiovascular mortality or repeat revascularization. Compared to short-term DAPT, 12-month DAPT or longer was associated with increased major bleeds (OR 1.98 95% CI: 1.26–3.11). No significant differences were found in the risk of other primary outcomes. Conclusion 12-month DAPT appears to be a pragmatic compromise between preventing stent thrombosis and increasing bleeding risk. Patients at high bleeding risk should have shorter duration DAPT while those with low bleeding risk can be considered for DAPT beyond 12 months. © 2016 Elsevier Ireland Ltd.-
dc.languageeng-
dc.publisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ijcard-
dc.relation.ispartofInternational Journal of Cardiology-
dc.rights© 2016 Elsevier Ireland Ltd.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleOptimal duration of dual antiplatelet therapy after drug-eluting stent implantation: Meta-analysis of randomized controlled trials-
dc.typeArticle-
dc.identifier.emailCheung, TT: tcheungt@hku.hk-
dc.identifier.emailCheung, BMY: mycheung@hkucc.hku.hk-
dc.identifier.authorityCheung, TT=rp01682-
dc.identifier.authorityCheung, BMY=rp01321-
dc.description.naturepostprint-
dc.identifier.doi10.1016/j.ijcard.2016.06.070-
dc.identifier.hkuros264980-
dc.identifier.volume220-
dc.identifier.spage895-
dc.identifier.epage900-
dc.publisher.placeIreland-
dc.customcontrol.immutablesml 161027 - 12 months embargo, published online: June 23, 2016-

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