CSHP Professional Practice Conference 2016: Poster Abstracts / Conférence sur la pratique professionnelle 2016 de la SCPH : Résumés des affiches Academic Article uri icon

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abstract

  • Background:

    Twelve months of dual antiplatelet therapy (DAPT) is recommended after percutaneous coronary intervention with drug-eluting stent implantation (PCI-DES). However, certain clinical scenarios may require premature discontinuation of therapy (e.g., urgent surgical procedures, major bleeding).

    Objective:

    To investigate clinically relevant efficacy and safety outcomes associated with a shorter duration of DAPT, compared to 12 months, after PCI-DES.

    Methods:

    A systematic search of Medline and Embase (inception to April 2015) was conducted. Included were randomized controlled trials that compared 6 months (or less) to 12 months of DAPT in patients who underwent PCI-DES. DAPT was defined as acetylsalicylic acid 75–200 mg daily and clopidogrel 75 mg daily. Outcomes of interest included death, myocardial infarction (MI), definite or probable stent thrombosis, major bleeding, and any bleeding. An odds ratio (OR) and 95% confidence interval (CI) were calculated for each outcome using a Mantel-Haenszel random effects model (Review Manager, version 5.3).

    Results:

    Five studies (4 open-label, 1 double-blind) were included constituting 12,078 patients. Three studies investigated 6 months of DAPT, and 2 studies investigated 3 months. Outcomes were reported at 12 months in 4 trials and 15 months in 1 trial. Efficacy outcomes were not statistically significantly different between groups including death (OR 0.85, 95% CI 0.61–1.18), MI (1.14, 0.85–1.55), and stent thrombosis (1.20, 0.67–2.15). There was no significant difference in major bleeding (0.61, 0.35–1.03); however, any bleeding was reduced by a relative 41% with shorter-term DAPT (0.59, 0.44–0.79).

    Conclusion:

    Shorter duration (3–6 months) of DAPT was not associated with a higher risk of death, MI, or stent thrombosis compared to 12 months. Furthermore, it was associated with a lower rate of overall bleeding, but not major bleeding. Though limited by low event rates and study methodology, these data support that DAPT could be safely discontinued before 12 months if required.

authors

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  • Barry, A
  • Lau, T
  • Wang, E
  • Ye, J
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  • Lee, C
  • Walker, SAN
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  • Palmay, L
  • Ng, J
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  • Wright, AE
  • Treleaven, S
  • Holbrook, A
  • Wallace, C
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  • Lebel, D
  • Roy, H
  • Ovetchkine, P
  • Bussières, JF
  • Halapy, H
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publication date

  • January 2016