Safety and efficacy of shortened dual antiplatelet therapy after complex percutaneous coronary intervention: A systematic review and meta-analysis

• Published in: Hellenic journal of cardiology Vol. 71; pp. 33 - 41
• Main Authors: Apostolos, Anastasios, Chlorogiannis, Dimitrios, Vasilagkos, Georgios, Katsanos, Konstantinos, Toutouzas, Konstantinos, Aminian, Adel, Alexopoulos, Dimitrios, Davlouros, Periklis, Tsigkas, Grigorios
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.05.2023; Elsevier
• Subjects: Bifurcations; Chronic total occlusion; Complex percutaneous coronary interventions; Drug Therapy, Combination; Dual Anti-Platelet Therapy; Dual antiplatelet therapy; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Myocardial Infarction - drug therapy; PCI; Percutaneous Coronary Intervention - adverse effects; Platelet Aggregation Inhibitors - adverse effects; Treatment Outcome; RCT; OR; CI; S-DAPT; L-DAPT; Bifurcations; Complex percutaneous coronary interventions; Chronic total occlusion; Dual antiplatelet therapy; BARC; MACE; PCI; DAPT
• ISSN: 1109-9666; 2241-5955
• DOI: 10.1016/j.hjc.2023.01.005

Optimal duration of dual antiplatelet therapy (DAPT) in patients undergoing complex percutaneous coronary intervention (PCI) remains under investigation. Our aim is to compare shortened (≤3 months) DAPT with longer DAPT in patients undergoing complex PCIs. Three major databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus) were screened. The primary endpoint was major bleedings as they are defined by the Bleeding Academic Research Consortium (BARC) 3–5. The secondary endpoints were major adverse cardiovascular events, all-cause and cardiovascular mortality, myocardial infarction, stroke, and stent thrombosis. Five studies were included in our analysis, with a total of 9,115 patients. Our meta-analysis met its primary endpoint, as abbreviated DAPT significantly reduced major bleedings by 43% (95% confidence intervals: 0.35–0.93). Ischemic events and mortality were not affected by the shortening of DAPT. Shortened DAPT significantly reduced the odds of major bleedings in patients undergoing complex PCI without increasing the ischemic events or mortality. Thus, it could be considered a safe and feasible option in such patients. Shortened DAPT is associated with significantly reduced major, BARC 3–5 bleedings, without increasing mortality and ischemic complications. Thus, it should be considered a safe and feasible approach in patients undergoing complex PCI. Maintenance is up to 12 months. A, aspirin; BARC, Bleeding Academic Research Consortium; C, clopidogrel; DAPT, dual antiplatelet therapy; PCI, percutaneous coronary interventions; P, prasugrel; S-DAPT, shortened DAPT; T, ticagrelor. [Display omitted]