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Conference Paper: Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: a network meta-analysis

TitleOptimal duration of dual antiplatelet therapy after drug-eluting stent implantation: a network meta-analysis
Authors
Issue Date2019
PublisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/
Citation
24th Medical Research Conference, Department of Medicine, The University of Hong Kong, Hong Kong, 19 January 2019. In Hong Kong Medical Journal, 2019, v. 25 n. 1, Suppl. 1, p. 18 How to Cite?
AbstractIntroduction: Although the recommended duration of dual antiplatelet therapy (DAPT) after drug-eluting stent implantation has been shortened in the current guidelines, the optimal duration is as controversial as ever. We therefore performed a network meta-analysis incorporating the latest trials to assess the risks and benefits of different DAPT durations. Methods: We searched for randomised controlled trials (RCTs) comparing different DAPT durations after drugeluting stent implantation and reporting frequencies of cardiovascular and bleeding events. Data analysis was performed using R statistics. Results: Fifteen RCTs with altogether 42 317 patients were finally included. Extended DAPT (>12 months) significantly reduced the frequencies of myocardial infarction (odds ratio [OR]=0.54, 95% confidence interval [CI]=0.44-0.65 and OR=0.54, 95% CI=0.41-0.70), and stent thrombosis (OR=0.43, 95% CI=0.29-0.63 and OR=0.51, 95% CI=0.33-0.78) when compared with 12-month and short-term DAPT (<12 months), respectively. However, the risk of major bleeding (OR=1.47, 95% CI=1.17-1.85 and OR=2.03, 95% CI=1.40-2.94) and all-cause mortality (OR=1.27, 95% CI=1.03-1.56 and OR=1.30, 95% CI=1.04-1.62) was substantially increased when compared with 12-month and short-term DAPT, respectively. No significant difference was found in cardiovascular mortality, stroke, and repeat revascularisation. Conclusion: Extended DAPT has the lowest rate of myocardial infarction and stent thrombosis, but the highest risk of major bleeding and all-cause mortality. Clinical trial evidence favours short-term more than extended DAPT because of increased mortality. Duration of DAPT should be individualised according to the risk–benefit profile of each patient.
Persistent Identifierhttp://hdl.handle.net/10722/268329
ISSN
2017 Impact Factor: 1.226
2015 SCImago Journal Rankings: 0.279

 

DC FieldValueLanguage
dc.contributor.authorFei, Y-
dc.contributor.authorTsoi, MF-
dc.contributor.authorCheung, BMY-
dc.date.accessioned2019-03-18T04:23:20Z-
dc.date.available2019-03-18T04:23:20Z-
dc.date.issued2019-
dc.identifier.citation24th Medical Research Conference, Department of Medicine, The University of Hong Kong, Hong Kong, 19 January 2019. In Hong Kong Medical Journal, 2019, v. 25 n. 1, Suppl. 1, p. 18-
dc.identifier.issn1024-2708-
dc.identifier.urihttp://hdl.handle.net/10722/268329-
dc.description.abstractIntroduction: Although the recommended duration of dual antiplatelet therapy (DAPT) after drug-eluting stent implantation has been shortened in the current guidelines, the optimal duration is as controversial as ever. We therefore performed a network meta-analysis incorporating the latest trials to assess the risks and benefits of different DAPT durations. Methods: We searched for randomised controlled trials (RCTs) comparing different DAPT durations after drugeluting stent implantation and reporting frequencies of cardiovascular and bleeding events. Data analysis was performed using R statistics. Results: Fifteen RCTs with altogether 42 317 patients were finally included. Extended DAPT (>12 months) significantly reduced the frequencies of myocardial infarction (odds ratio [OR]=0.54, 95% confidence interval [CI]=0.44-0.65 and OR=0.54, 95% CI=0.41-0.70), and stent thrombosis (OR=0.43, 95% CI=0.29-0.63 and OR=0.51, 95% CI=0.33-0.78) when compared with 12-month and short-term DAPT (<12 months), respectively. However, the risk of major bleeding (OR=1.47, 95% CI=1.17-1.85 and OR=2.03, 95% CI=1.40-2.94) and all-cause mortality (OR=1.27, 95% CI=1.03-1.56 and OR=1.30, 95% CI=1.04-1.62) was substantially increased when compared with 12-month and short-term DAPT, respectively. No significant difference was found in cardiovascular mortality, stroke, and repeat revascularisation. Conclusion: Extended DAPT has the lowest rate of myocardial infarction and stent thrombosis, but the highest risk of major bleeding and all-cause mortality. Clinical trial evidence favours short-term more than extended DAPT because of increased mortality. Duration of DAPT should be individualised according to the risk–benefit profile of each patient.-
dc.languageeng-
dc.publisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/-
dc.relation.ispartofHong Kong Medical Journal-
dc.relation.ispartof24th Annual Medical Research Conference, Department of Medicine, The University of Hong Kong-
dc.rightsHong Kong Medical Journal. Copyright © Hong Kong Academy of Medicine Press.-
dc.titleOptimal duration of dual antiplatelet therapy after drug-eluting stent implantation: a network meta-analysis-
dc.typeConference_Paper-
dc.identifier.emailCheung, BMY: mycheung@hkucc.hku.hk-
dc.identifier.authorityCheung, BMY=rp01321-
dc.identifier.hkuros297251-
dc.identifier.volume25-
dc.identifier.issue1, Suppl. 1-
dc.identifier.spage18-
dc.identifier.epage18-
dc.publisher.placeHong Kong-

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