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Title: | Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials | Authors: | Costa, Francesco Montalto, Claudio Branca, Mattia Hong, Sung-Jin Watanabe, Hirotoshi Franzone, Anna VRANCKX, Pascal Hahn, Joo-Yong Gwon, Hyeon-Cheol Feres, Fausto Jang, Yangsoo De Luca, Giuseppe Kedhi, Elvin Cao, Davide Steg, Philippe Gabriel Bhatt, Deepak L. Stone, Gregg W. Micari, Antonio Windecker, Stephan Kimura, Takeshi Hong, Myeong-Ki Mehran, Roxana Valgimigli, Marco |
Issue Date: | 2022 | Publisher: | OXFORD UNIV PRESS | Source: | EUROPEAN HEART JOURNAL, 44 (11), p. 954-968 | Abstract: | Aims The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) is still debated. The current study, using the totality of existing evidence, evaluated the impact of an abbreviated DAPT regimen in HBR patients. Methods and results A systematic review and meta-analysis was performed to search randomized clinical trials comparing abbreviated [i.e. very-short (1 month) or short (3 months)] with standard (>= 6 months) DAPT in HBR patients without indication for oral anticoagulation. A total of 11 trials, including 9006 HBR patients, were included. Abbreviated DAPT reduced major or clinically relevant non-major bleeding [risk ratio (RR): 0.76, 95% confidence interval (CI): 0.61-0.94; I-2 = 28%], major bleeding (RR: 0.80, 95% CI: 0.64-0.99, I-2 = 0%), and cardiovascular mortality (RR: 0.79, 95% CI: 0.65-0.95, I-2 = 0%) compared with standard DAPT. No difference in all-cause mortality, major adverse cardiovascular events, myocardial infarction, or stent thrombosis was observed. Results were consistent, irrespective of HBR definition and clinical presentation. Conclusion In HBR patients undergoing PCI, a 1- or 3-month abbreviated DAPT regimen was associated with lower bleeding and cardiovascular mortality, without increasing ischaemic events, compared with a >= 6-month DAPT regimen. Study registration PROSPERO registration number CRD42021284004 | Notes: | Costa, F (corresponding author), Univ Messina, AOU Policlin G Martino, Dept Biomed & Dent Sci & Morphol & Funct Imaging, I-98100 Messina, Italy. fcosta@unime.it |
Keywords: | Dual antiplatelet therapy;High bleeding risk;Percutaneous coronary intervention;Aspirin;Monotherapy | Document URI: | http://hdl.handle.net/1942/39104 | ISSN: | 0195-668X | e-ISSN: | 1522-9645 | DOI: | 10.1093/eurheartj/ehac706 | ISI #: | 000893552200001 | Rights: | The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2023 |
Appears in Collections: | Research publications |
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Dual Antiplatelet.pdf | Peer-reviewed author version | 546.4 kB | Adobe PDF | View/Open |
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