Author + information
- Georges El-Hayek,
- Alexandre Benjo,
- Daniel Garcia,
- Mun Hong,
- Eyal Herzog and
- Jacqueline Tamis-Holland
Current guidelines recommend 12 months of dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) in the absence of increased bleeding risk. Early discontinuation of DAPT has been shown to increase the risk of stent thrombosis. However, given the potential for major bleeding (MB), the optimal duration of DAPT after DES remains uncertain.
We searched PubMed, Scopus and ClinicalTrials.gov databases till October 2013 for randomized controlled trials (RCTs) that compared shorter versus longer DAPT duration after DES. Odds ratios (ORs) with 95% confidence interval (CI) for cardiovascular events including cardiac death, myocardial infarction, and stent thrombosis (MACE) and MB were calculated using fixed-effects model.
Four RCTs were included. A total of 4081 patients received DAPT for 3 to 6 months and 4076 were treated with DAPT for 12 to 24 months. Oral DAPT consisted of aspirin and clopidogrel. There was no significant difference in MACE between the short and prolonged DAPT groups (Figure). A Landmark analysis performed at the time of discontinuation of DAPT in the short DAPT group failed to show a significant difference in stent thrombosis for short vs prolonged therapy (0.35% vs 0.20% p=0.22). Major bleeding was significantly lower in the group of patients treated with short DAPT (0.29% vs 0.71%, p=0.01).
Prolonged DAPT as compared with short-term treatment is associated with increased major bleeding but does not appear to improve cardiac events.
Saturday, March 29, 2014, 3:45 p.m.-4:30 p.m.
Session Title: Clinical Aspects of Anti Platelet Therapy in Acute Coronary Syndrome
Abstract Category: 3. Acute Coronary Syndromes: Therapy
Presentation Number: 1151-228
- 2014 American College of Cardiology Foundation