Meta-Analysis of the Duration of Dual Antiplatelet Therapy in Patients Treated With Second-Generation Drug-Eluting Stents

D’Ascenzo, Fabrizio; Moretti, Claudio; Bianco, Matteo; Bernardi, Alessandro; Taha, Salma; Cerrato, Enrico; Omedè, Pierluigi; Montefusco, Antonio; Frangieh, Antonio H.; Lee, Cheol W.; Campo, Gianluca; Chieffo, Alaide; Quadri, Giorgio; Pavani, Marco; Zoccai, Giuseppe Biondi; Gaïta, Fiorenzo; Park, Seung Jung; Colombo, Antonio; Templin, Christian; Lüscher, Thomas F.; Stone, Gregg W.

doi:10.1016/j.amjcard.2016.03.005

Cited by 58 publications

(47 citation statements)

References 31 publications

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“…On the other hand, the cumulative incidence of major bleeding gradually increased in patients after BP-BES implantation. It has been reported that prolonged dual antiplatelet therapy significantly increased the risk of major bleeding 26. We could not assess the difference in the cumulative incidence of major bleeding by landmark analysis based on the duration of dual antiplatelet therapy due to its low incidence.…”

Section: Discussionmentioning

confidence: 94%

Long-term (8–10 years) outcomes after biodegradable polymer-coated biolimus-eluting stent implantation

Ohya

Kubo

Kuwayama

et al. 2017

Heart

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Section: Discussionmentioning

confidence: 94%

Long-term (8–10 years) outcomes after biodegradable polymer-coated biolimus-eluting stent implantation

Ohya

Kubo

Kuwayama

et al. 2017

Heart

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“…These results are consistent with those of Mehran et al [22] who found that cardiac events after DAPT cessation depend on the clinical circumstance and reason for cessation and attenuates over time; yet the authors did not focus on Chinese population. Nonetheless, in a meta-analysis of the duration of DAPT in patients treated with secondgeneration drug-eluting stents, major bleeding was reduced by shorter DAPT (OR: 0.60; 95% CI: 0.42 to 0.96), emphasizing the need for an individualized approach to balance the competing risks of bleeding and myocardial infarction when deciding on the optimal DAPT duration for each patient [32]. Third, in general, management of antiplatelet-related bleeding complications includes identification and treatment of the bleeding source, haemostatic intervention (manual, endoscopic, and surgical), discontinuation of antithrombotic drugs (partial or complete), replacement therapy, and antidotes if available, depending on bleeding severity and risk of ischaemic recurrence [5,33,34].…”

Section: Discussionmentioning

confidence: 99%

Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients

Wan

Zhou

Liu

et al. 2018

Cell Physiol Biochem

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Background/Aims: Bleeding complications after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes. However, there are no specific guidelines for the predictors and management of antiplatelet-related bleeding complications in Chinese elderly patients with acute coronary syndrome (ACS). Methods: A retrospective analysis of 237 consecutive patients (aged ≥ 75 years) with ACS who had undergone successful PCI from January 2010 to December 2016 was performed to identify predictors and management of antiplatelet-related bleeding complications. Multivariate logistic regression analysis was conducted to investigate independent predictors of antiplatelet-related bleeding complications. We defined antiplatelet-related bleeding complications as first hospitalization received long-term oral antiplatelet therapy and required hospitalization, including gastrointestinal and intracranial bleedings. Results: After multivariable adjustment, independent risk predictors of antiplatelet-related bleeding complications included female gender (odds ratio [OR]: 2.96; 95% confidence interval [CI]: 1.98 to 4.15; P = 0.011), body mass index (OR: 1.54; 95% CI: 1.06 to 1.94; P = 0.034), previous history of bleeding (OR: 4.03; 95% CI: 1.84 to 6.12; P = 0.004), fasting blood glucose (OR: 2.79; 95% CI: 1.23 to 4.46; P = 0.025), and chronic total occlusion lesion (OR: 4.69; 95% CI: 2.19 to 7.93; P = 0.007). Of 46 patients with antiplatelet-related bleeding complications, 54.3% were treated short-term dual antiplatelet therapy (DAPT) cessation (0–7 days) and 45.7% underwent long-term DAPT cessation (> 7 days). Among these, 14 patients presented major adverse cardiac and cerebrovascular events (MACCE), whereas no re-bleeding happened over all available follow-up. The incidence of MACCE was not significantly different between the two groups one year after PCI (36.0% for short-term DAPT cessation versus 23.8% for long-term DAPT cessation, P = 0.522). Conclusion: For elderly patients with ACS, multiple factors were likely to contribute to antiplatelet-related bleeding complications, especially previous history of bleeding and chronic total occlusion lesion. Better individualized, tailored and risk-adjusted antiplatelet therapy after PCI is urgently needed in this high-risk population.

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“…37 A recent meta-analysis compared different protocols enlightening their high safety profile and efficacy; desensitization was also performed in ACS patients, who represented 55% of the population. 45 This work compared the intravenous desensitization protocol to the oral protocol: desensitization was successful in almost all patients (98%, 95.9% and 95.8%, respectively). Incidence of urticaria, angioedema, and asthma during desensitization was less than 5% in all studies considered, and in most cases patients were desensitized restarting with the last tolerated dose before treatment interruption.…”

Section: Management Of Aspirin-intolerant Patientsmentioning

confidence: 99%

Is Aspirin Still the Cornerstone of Antiplatelet Therapy in Patients With Coronary Artery Disease? An Historical and Practical Narrative Review

et al. 2017

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Meta-Analysis of the Duration of Dual Antiplatelet Therapy in Patients Treated With Second-Generation Drug-Eluting Stents

Cited by 58 publications

References 31 publications

Long-term (8–10 years) outcomes after biodegradable polymer-coated biolimus-eluting stent implantation

Long-term (8–10 years) outcomes after biodegradable polymer-coated biolimus-eluting stent implantation

Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients

Is Aspirin Still the Cornerstone of Antiplatelet Therapy in Patients With Coronary Artery Disease? An Historical and Practical Narrative Review

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