Abstract | BACKGROUND: METHODS: PUBMED and EMBASE were searched through March 2020 for randomized controlled trials evaluating short-term DAPT (≤6 months) when compared with longer-term (≥12 months) DAPT among patients undergoing PCI. The ischemic outcomes were all-cause death, myocardial infarction, stent thrombosis, and stroke. The safety outcome was major and/or clinically relevant bleeding. The primary objective was to investigate the outcomes with aspirin monotherapy ( Aspirin group) versus P2Y12 inhibitor monotherapy (P2Y12i group) after short-term DAPT. RESULTS: Our search identified 17 eligible trials enrolling a total of 54,625 patients comparing different DAPT duration. Either of the 2 monotherapy groups did not increase the risk of ischemic outcomes when compared with the long-term DAPT group, without difference between the Aspirin versus the P2Y12i groups. However, both monotherapy groups significantly reduced bleeding when compared with long-term DAPT ( Aspirin group: hazard ratio [95% CI]: 0.62 [0.45-0.86], P=.004 and P2Y12i group: 0.68 [0.50-0.93], P=.015). There was no difference in bleeding between the Aspirin versus P2Y12i groups (hazard ratio=0.91 [0.58-1.43], P=.70). CONCLUSIONS: Among patients undergoing PCI, short-term DAPT with continuation of either aspirin or P2Y12i reduced bleeding without increasing ischemic outcomes when compared with long-term DAPT. The choice of antiplatelet therapy after short-term DAPT should be evaluated in well-powered trials.
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Authors | Toshiki Kuno, Hiroki Ueyama, Hisato Takagi, Sripal Bangalore |
Journal | American heart journal
(Am Heart J)
Vol. 227
Pg. 82-90
(09 2020)
ISSN: 1097-6744 [Electronic] United States |
PMID | 32693196
(Publication Type: Comparative Study, Journal Article, Meta-Analysis)
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Copyright | Copyright © 2020 Elsevier Inc. All rights reserved. |
Chemical References |
- Platelet Aggregation Inhibitors
- Purinergic P2Y Receptor Antagonists
- Aspirin
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Topics |
- Aspirin
(administration & dosage)
- Dual Anti-Platelet Therapy
(methods)
- Humans
- Network Meta-Analysis
- Percutaneous Coronary Intervention
- Platelet Aggregation Inhibitors
(administration & dosage)
- Purinergic P2Y Receptor Antagonists
(administration & dosage)
- Randomized Controlled Trials as Topic
- Time Factors
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