In a nutshell
The authors studied the best duration for dual antiplatelet therapy (DAPT) after a percutaneous coronary intervention. Shorter DAPT duration was associated with higher rates of total heart attacks, lower rates of major bleeding, and similar rates of death.
A percutaneous coronary intervention (PCI) is a procedure done to improve blood flow to the heart. A drug-eluting stent (mesh wire structure that releases drugs) is sometimes used. After such a procedure, antiplatelet drugs can be given to prevent blood from clotting. Dual antiplatelet therapy, which is treatment with 2 different antiplatelet drugs, is often recommended after PCI. It is suggested that some patients may benefit from longer DAPT.
Methods & findings
The authors analyzed a total of 8 studies with 18,810 patients who received a drug-eluting stent. 12,510 were treated with everolimus (Afinitor)-eluting stents, 5768 were treated with fast-release zotarolimus-eluting stents, and 532 were treated with biolimus-eluting stents.
Comparing short term (less than 12 months) versus long term (more than 12 months) DAPT, there were no significant differences in the risk of death from all causes or risk of death from heart attack.
Patients who received shorter DAPT were 35% more likely to experience a non-fatal heart attack compared to patients who received longer DAPT. The risk of a heart attack was 61% higher with 12 months of DAPT compared to 30 months of DAPT. However, there were no significant differences between 6 or less months versus 12 months of DAPT. The risk of major bleeding was 40% lower with shorter DAPT compared to longer DAPT.
The bottom line
The authors concluded that 6 months or less of DAPT is beneficial for patients treated with everolimus-eluting and fast-release zotarolimus-eluting stents.
The fine print
The various studies included used different classifications for severe bleeding.
Published By :
The American journal of cardiology
Jun 01, 2016
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