Safety and efficacy of interrupting dual antiplatelet therapy one month following percutaneous coronary intervention: a meta-analysis of randomized controlled trials

Abstract

Very short duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) has recently attracted a lot of attention with the introduction of newer generations stents. This is appealing, especially in patients at high bleeding risk. However, none of the trials were powered for the individual ischemic and bleeding endpoints. All randomised controlled trials (RCTs) investigating one-month versus routine duration of DAPT in patients undergoing PCI and reporting outcomes from the time of cessation of DAPT (1 month) to 1 year were eligible for inclusion in the meta-analysis. The pooled risk ratios (RR) with their 95% confidence interval (CI) were calculated with the random-effects model using the Mantel-Haenszel method. Four RCTs involving 26,576 patients were included in this meta-analysis. Cessation of DAPT after 1 month was associated with significantly less major bleeding [RR 0.70, 95%CI (0.51–0.95), P = 0.02, heterogeneity (I2) = 42%]. There was no statistically significant difference in all-cause mortality [RR 0.84 (95%CI 0.69–1.03), P = 0.10, I2 = 0%] and stroke [RR 0.71 (95%CI 0.45–1.13), P = 0.15, I2 = 42%] when compared to routine duration of DAPT. There was also no difference in myocardial infarction (MI) [RR 1.12 (95%CI 0.91–1.39), P = 0.28, I2 = 0%], and definite or probable stent thrombosis [RR 1.49 (95%CI 0.92–2.41), P = 0.11, I2 = 0%] with cessation of DAPT after 1 month. Cessation of DAPT 1 month after PCI was associated with significantly less major bleeding, but there was no difference in the rate of all-cause mortality, stroke, MI and stent thrombosis.

Patient-Related Factors Predicting Stent Thrombosis in Percutaneous Coronary Interventions

“…The STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2) trial found that in PCI patients, one month of DAPT followed by clopidogrel monotherapy had a much lower rate of cardiovascular and bleeding events than 12 months of DAPT with aspirin and clopidogrel. Additionally, a recent meta-analysis of these studies found no significant differences between the rates of all-cause mortality, stroke, MI, and ST during the follow-up period of 1 month to 1 year when comparing one-month DAPT to routine DAPT in patients undergoing PCI [4,[11][12][13].…”

“…Shorter DAPT durations after ACS were associated with higher rates of ST and myocardial infarction [8,9]; • No differences between short-duration and standard-duration DAPT in terms of effectiveness results, with short-term DAPT being an option for patients at high risk of bleeding [3]; • A single month of DAPT was non-inferior to the long-term DAPT in terms of the risk of MACE [4,11,13]; • DAPT withdrawal was not linked to poorer 1-year TLF following COMBO stenting [17]; • Younger patients had a higher cardiovascular risk associated with disruption, whereas those over 75 did not [18]; •…”

A Contemporary Review of Antiplatelet Therapies in Current Clinical Practice

“…The latest ESC guidelines [ 24 ] recommend six months of DAPT, whereas the ACC/AHA guidelines [ 25 ] recommend three to six months of DAPT following elective PCI (EXCELLENT [ 26 ], SECURITY [ 27 ] AND ISAR-SAFE [ 28 ] trials). The benefit beyond this period is minimal at the expense of an increased risk of major bleeding [ 29 , 30 ] and non-cardiovascular death [ 31 , 32 , 33 ], as shown in several meta-analyses. A shorter duration of dual antiplatelet medication (between one and three months) can be considered in patients with high bleeding risk (GLOBAL LEADERS [ 34 ], MASTER DAPT [ 35 ], STOPDAPT 2 [ 36 ] and one-month DAPT [ 37 ] trials).…”

Avaliação da duração e do risco de sangramento entre diferentes estratégias de dupla antiagregação plaquetária administradas após a intervenção coronária percutânea: uma revisão de escopo

“…Assim como Zhong e colaboradores apontaram que a redução da taxa de sangramento maior a partir do uso de TDAP abreviada esteve em uma faixa entre (43%-46%), os benefícios dessa estratégia também foram sustentados pelos estudos de Parfrey, et al, 2022;Rout, et al, 2023;Benenati, et al, 2021;Landi, et al, 2023).…”