Short‐versus long‐term Dual Antiplatelet therapy after drug‐eluting stent implantation in women versus men: A sex‐specific patient‐level pooled‐analysis of six randomized trials

Sawaya, Fadi J.; Morice, Marie Claude; Spaziano, Marco; Mehran, Roxana; Didier, Romain; Roy, Andrew K.; Valgimigli, Marco; Kim, Hyo Soo; Park, Kyung Woo; Hong, Myeong Ki; Kim, Byeong Keuk; Jang, Yangsoo; Feres, Fausto; Abizaid, Alexandre; Costa, Ricardo; Colombo, Antonio; Chieffo, Alaide; Giustino, Gennaro; Stone, Gregg W.; Bhatt, Deepak L.; Palmerini, Tullio; Gilard, Martine

doi:10.1002/ccd.26653

Cited by 25 publications

(18 citation statements)

References 42 publications

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“…Our current analysis already involved participants with thrombocytopenia, and therefore, logically, longer duration of DAPT use might not be tolerable in similar patients following PCI. Another study showed short term DAPT use to be equally effective and safer compared to long term DAPT use following stents implantation with drug eluting stents [30].…”

Section: Discussionmentioning

confidence: 99%

“…-They were literature reviews (3); -They were case studies 17; -They were based on thrombocytopenia after PCI and did not involve participants with thrombocytopenia at baseline (26); -They were letters of correspondence (4); -They were duplicated studies from several different search databases (30).…”

Section: Outcome Of the Search Process And The Selection Of Studiesmentioning

confidence: 99%

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Dual anti-platelet therapy following percutaneous coronary intervention in a population of patients with thrombocytopenia at baseline: a meta-analysis

Long

Zheng

et al. 2020

BMC Pharmacol Toxicol

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Background: In this meta-analysis, we aimed to systematically compare the post percutaneous coronary interventional (PCI) adverse bleeding events, stent thrombosis, stroke and other cardiovascular outcomes in a population of patients with and without thrombocytopenia at baseline who were followed up on dual antiplatelet therapy (DAPT). Methods: Relevant English language articles which were published before June 2019 were retrieved from MEDLINE, http://www.ClinicalTrials.com, EMBASE, Cochrane central, and Google scholar briefly using specific terms such as percutaneous coronary intervention or dual antiplatelet therapy, and thrombocytopenia. All the participants were followed up on DAPT following discharge. Specific endpoints including bleeding events, stent thrombosis, stroke and other adverse cardiovascular events were assessed. The latest version of the RevMan software was used for the statistical assessment. Odd ratios (OR) with 95% confidence intervals (CI) based on a fixed or a random statistical model were used to represent the data graphically. Results: A total number of 118,945 participants (from 8 studies) were included with 37,753 suffering from thrombocytopenia at baseline. Our results showed post procedural bleeding (

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Section: Discussionmentioning

confidence: 99%

Section: Outcome Of the Search Process And The Selection Of Studiesmentioning

confidence: 99%

Dual anti-platelet therapy following percutaneous coronary intervention in a population of patients with thrombocytopenia at baseline: a meta-analysis

Long

Zheng

et al. 2020

BMC Pharmacol Toxicol

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“…Gender was not a treatment modifier in terms of DAPT duration and men and women had similar adjusted 2-year ischemic and bleeding outcomes. On the same hand, a pooled analysis of six randomized trials showed that in both sexes short DAPT is associated with similar rates of cardiovascular outcomes but lower risk of bleeding when compared with prolonged DAPT [70].…”

Section: Dual Antiplatelet Therapymentioning

confidence: 99%

Gender differences in cardiovascular prophylaxis: Focus on antiplatelet treatment

Giosia

Passacquale

Petrarca

et al. 2017

Pharmacological Research

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Cardiovascular disease (CVD) represents the leading cause of death worldwide, and equally affects both sexes although women develop disease at an older age than men. A number of clinical evidence has identified the female sex as an independent factor for poor prognosis, with the rate of mortality and disability following an acute cardiovascular (CV) event being higher in women than men. It has been argued that the different level of platelet reactivity between sexes may account for a different responsiveness to anti-platelet therapy, with consequent important implications on clinical outcomes. However, conclusive evidence supporting the concept of a gender-dependent effectiveness of platelet inhibitors are lacking. On the contrary, sex-related dissimilarities have been evidenced in cardiovascular patients in terms of age of presentation, comorbidities such as obesity, diabetes and renal disease, and a different pharmacological approach to and effectiveness in controlling classical cardiovascular risk factors such as hypertension, glucose profile and lipid dysmetabolism. All these factors could place women at an increased level of cardiovascular risk compared to men, and may concur to an enhanced pro-thrombogenic profile. The purpose of this manuscript is to provide an overview of gender-related differences in cardiovascular treatment, in order to highlight the need to improve the pharmacological prophylaxis adopted in women through a more accurate evaluation of the overall cardiovascular risk profile with consequent establishment of a more effective and targeted anti-thrombotic strategy which is not limited to the use of antiplatelet agents.

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“…Multiple randomized clinical trials (RCTs) have evaluated the safety and efficacy of different DAPT durations with conflicting results [12][13][14][15]. Previous meta-analyses and systematic review have also shown mixed results [16][17][18][19]. Therefore, we conducted our network metaanalysis to evaluate the safety and efficacy of various DAPT durations in patients undergoing DES implantation.…”

Section: Introductionmentioning

confidence: 99%

Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials

Barbarawi

Kheiri

Zayed

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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Background: Drug-eluting stent(DES) implantation is the main interventional treatment for coronary artery disease, and dual antiplatelet therapy(DAPT) remains the gold standard strategy to prevent ischemic events. However, the optimal duration of DAPT after DES implantation remains controversial. Therefore, we aimed to evaluate the best duration of DAPT following DES implantation.Method: We searched PubMed, Embase, Cochrane Library, and clinicaltrials.gov for all randomized clinical trials(RCTs) that compared different durations of DAPT after DES implantation. Major adverse cardiac events(MACE) and major bleeding were the primary and secondary outcomes, respectively.Results: We included 16 RCTs (n = 42,993). The mean age of included patients was 63.1 ± 10.1. The primary outcome was statistically significant for lower MACE in patients who received DAPT for 24–48 months (mo) following DES when compared with those who received 3–6 mo of DAPT (odds ratio [OR] 0.75; 95% credible interval [CI] 0.58–0.97). There was nonstatistically significant difference in MACE when comparing those who received 12 mo of DAPT to those taking either 3–6 mo of DAPT (OR 0.86; 95% CI 0.69–1.08) or 24–48 mo of DAPT (OR 0.87; 95% CI 0.72–1.05). In contrast, major bleeding was significantly lower in those who received 3–6 mo of DAPT (OR 0.32; 95% CI 0.17–0.54) and 12 mo of DAPT (OR 0.43; 95% CI 0.27–0.63) than in those who received 24–48 mo of DAPT.Conclusion: In patients who undergo DES implantation, a longer duration of DAPT is associated with lower MACE, despite the increased risk of major bleeding events. Therefore, individualizing the duration of DAPT after DES according to the patient’s risk of bleeding and recurrent ischemia is recommended.

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Short‐versus long‐term Dual Antiplatelet therapy after drug‐eluting stent implantation in women versus men: A sex‐specific patient‐level pooled‐analysis of six randomized trials

Abstract: Short-term DAPT is associated with similar rates of MACE but lower risk of bleeding when as compared with prolonged DAPT. There was no significant difference between sexes in the population studied. © 2016 Wiley Periodicals, Inc.

Cited by 25 publications

References 42 publications

Dual anti-platelet therapy following percutaneous coronary intervention in a population of patients with thrombocytopenia at baseline: a meta-analysis

Dual anti-platelet therapy following percutaneous coronary intervention in a population of patients with thrombocytopenia at baseline: a meta-analysis

Gender differences in cardiovascular prophylaxis: Focus on antiplatelet treatment

Best duration of dual antiplatelet therapy after drug-eluting stent implantation: an updated network meta-analysis of randomized controlled trials

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