Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation Drug-eluting Stents: A Meta-analysis and Systematic Review

Huang Peisen; Yu Yuan; Han Xikun; Yang Yuejin

Your Location：

Home >

Browse articles >

Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation Drug-eluting Stents: A Meta-analysis and Systematic Review

中国医学科学杂志（英文版） 2017年32卷第1期页码：1-12

Orginal Article | Updated：2024-04-10

- Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation Drug-eluting Stents: A Meta-analysis and Systematic Review
- Affiliations：
  
  1.1State Key Laboratory of Cardiovascular Disease
  2.2National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
- Author bio：
  
  *Corresponding author Tel: 86-10-88398760, Fax: 86-10-68351786, E-mail: yangyjfw@126.com
- Funds：
- DOI：
  中图分类号：
- 网络出版日期：2016-03-03，
  
  纸质出版日期：2017-04
- Accepted：
Scan QR Code
Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation Drug-eluting Stents: A Meta-analysis and Systematic Review[J]. 中国医学科学杂志（英文版）, 2017,32(1):1-12.

Huang Peisen, Yu Yuan, Han Xikun, et al. Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation Drug-eluting Stents: A Meta-analysis and Systematic Review[J]. Chinese medical sciences journal, 2017, 32(1): 1-12.
Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation Drug-eluting Stents: A Meta-analysis and Systematic Review[J]. 中国医学科学杂志（英文版）, 2017,32(1):1-12. DOI：

Huang Peisen, Yu Yuan, Han Xikun, et al. Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation Drug-eluting Stents: A Meta-analysis and Systematic Review[J]. Chinese medical sciences journal, 2017, 32(1): 1-12. DOI：

摘要

Abstract

Objective

The benefit of short-term dual antiplatelet therapy (DAPT) following second-generation drug-eluting stents implantation has not been systematically evaluated. To bridge the knowledge gap

we did a meta-analysis to assess the efficacy of ≤6 months

versus

≥12 months DAPT among patients with second-generation drug-eluting stents.

Methods

We searched online databases and identified randomized controlled trials that assess the clinical impact of short-term DAPT (≤6 months) published before March 3

2016. The efficacy endpoints included the incidence of all-cause death

myocardial infarction

cerebrovascular accidents

and definite or probable stent thrombosis. Safety endpoint defined as major bleeding was also evaluated and discussed.

Results

We included 5 trials that randomized 9473 participants (49.8%

short-term DAPT duration

. 50.2%

standard duration). A total of 9445 (99.7%) patients reported the efficacy endpoints

and the safety endpoint was available from 4 studies (

=8457). There was no significant difference in efficacy endpoints between short-term and standard DAPT duration (≥12 months) [risk ratio (

) 0.96; 95% confidence intervals (

)

0.80-1.15]. Short-term DAPT duration did not significantly increase the individual risk of all-cause death

myocardial infarction

cerebrovascular accidents

or definite or probable stent thrombosis. Although short-term DAPT obviously reduced risk of major bleeding compared with standard DAPT (

0.53; 95%

0.29-0.96)

significant publication bias was found when accessing the safety endpoint of the 4 studies (Egger’s test

=0.009).

Conclusions

The efficacy of short-term DAPT was comparable with that of standard duration DAPT. DAPT less than 6 months may be appropriate for patients receiving second-generation drug-eluting stents implantation.

关键词

Keywords

references

Mauri L , Kereiakes DJ , Yeh RW , et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med 2014 ; 371 : 2155 - 66 .

Wijns W , Steg PG , Mauri L , et al. Endeavour zotarolimus-eluting stent reduces stent thrombosis and improves clinical outcomes compared with cypher sirolimus-eluting stent: 4-year results of the PROTECT randomized trial. Eur Heart J 2014 ; 35 : 2812 - 20 .

Dangas GD , Serruys PW , Kereiakes DJ , et al. Meta-analysis of everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease: final 3-year results of the SPIRIT clinical trials program (Clinical Evaluation of the Xience V Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions). JACC Cardiovasc Interv 2013 ; 6 : 914 - 22 .

Finn AV , Joner M , Nakazawa G , et al. Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 2007 ; 115 : 2435 - 41 .

Kandzari DE , Barker CS , Leon MB , et al. Dual antiplatelet therapy duration and clinical outcomes following treatment with zotarolimus-eluting stents. JACC Cardiovasc Interv 2011 ; 4 : 1119 - 28 .

Windecker S , Kolh P , Alfonso F , et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014 ; 35 : 2541 - 619 .

Levine GN , Bates ER , Blankenship JC , et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011 ; 58 : e44 - e122 .

Ziada KM , Abdel-Latif A , Charnigo R , et al. Safety of an abbreviated duration of dual antiplatelet therapy (≤6 months) following second-generation drug-eluting stents for coronary artery disease: a systematic review and meta-analysis of randomized trials. Catheter Cardiovasc Interv 2016 ; 87 : 722 - 32 .

Higgins JPT , Sterne JAC , Altman DG , et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011 ; 343 : 889 - 93 .

Higgins JP , Thompson SG , Deeks JJ , et al. Measuring inconsistency in meta-analyses. BMJ 2003 ; 327 : 557 - 60 .

Sterne JA , Egger M , Smith GD. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ 2001 ; 323 : 101 - 5 .

Gilard M , Barragan P , Noryani AA , et al. 6- versus 24-month dual antiplatelet therapy after implantation of drug-eluting stents in patients nonresistant to aspirin: the randomized, multicenter ITALIC trial. J Am Coll Cardiol 2015 ; 65 : 777 - 86 .

Colombo A , Chieffo A , Frasheri A , et al. Second-generation drug-eluting stent implantation followed by 6- versus 12-month dual antiplatelet therapy: the SECURITY randomized clinical trial. J Am Coll Cardiol 2014 ; 64 : 2086 - 97 .

Feres F , Costa RA , Abizaid A , et al. Three vs . twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA 2013 ; 310 : 2510 - 22 .

Valgimigli M , Borghesi M , Tebaldi M , et al. Should duration of dual antiplatelet therapy depend on the type and/ or potency of implanted stent? A pre-specified analysis from the PROlonging dual antiplatelet treatment after grading stent-induced intimal hyperplasia study (PRODIGY). Eur Heart J 2013 ; 34 : 909 - 19 .

Kim BK , Hong MK , Shin DH , et al. A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (real safety and efficacy of 3-month dual antiplatelet therapy following endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol 2012 ; 60 : 1340 - 8 .

Chen ZM , Jiang LX , Chen YP , et al. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005 ; 366 : 1607 - 21 .

Sardella G , Mancone M , Biondi-Zoccai G , et al. Beneficial impact of prolonged dual antiplatelet therapy after drug-eluting stent implantation. J Interv Cardiol 2012 ; 25 : 596 - 603 .

Faxon DP , Lawler E , Young M , et al. Prolonged clopidogrel use after bare metal and drug-eluting stent placement: the veterans administration drug-eluting stent study. Circ Cardiovasc Interv 2012 ; 5 : 372 - 80 .

Eisenstein EL , Kandzari DE , Peterson ED , et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA 2007 ; 297 : 159 - 68 .

21.Tanzilli G , Greco C , Pelliccia F , et al . Effectiveness of two-year clopidogrel + aspirin in abolishing the risk of very late thrombosis after drug-eluting stent implantation (from the TYCOON [two-year ClOpidOgrel need] study). Am J Cardiol 2009 ; 104 : 1357 - 61 .

Kwok CS , Bulluck H , Ryding AD , et al. Benefits and harms of extending the duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stents: a meta-analysis. Scientific World J 2014 ; 2014 : 794078 .

Palmerini T , Benedetto U , Bacchi-Reggiani L , et al. Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials. Lancet 2015 ; 385 : 2371 - 82 .

Spencer FA , Prasad M , Vandvik PO , et al. Longer- versus shorter-duration dual-antiplatelet therapy after drug-eluting stent placement: a systematic review and meta-analysis. Ann Intern Med 2015 ; 163 : 118 - 26 .

Giustino G , Baber U , Sartori S , et al. Duration of dual antiplatelet therapy after drug-eluting stent implantation: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Cardiol 2015 ; 65 : 1298 - 310 .

Yeh RW , Mauri L , Kereiakes DJ. Dual antiplatelet therapy duration following coronary stenting. J Am Coll Cardiol 2015 ; 65 : 787 - 90 .

Bonaca MP , Bhatt DL , Cohen M , et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015 ; 372 : 1791 - 800 .

Montalescot G , Wiviott SD , Braunwald E , et al. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 2009 ; 373 : 723 - 31 .

浏览量

1884

Downloads

CSCD

文章被引用时，请邮件提醒。

Submit

关联资源

Transarterial Embolization versus Translumber Embolization for Type Ⅱ Endoleak after Endovascular Abdominal Aortic Aneurysm Repair: A Meta-Analysis

Effects of Exercise on Cancer-related Fatigue and Quality of Life in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Meta-analysis of Randomized Clinical Trials

Meta-analysis of aspirin-heparin therapy for un-explained recurrent miscarriage

Efficacy of Topical Tacrolimus for Erosive Oral Lichen Planus: A Meta-analysis

Association between Two Polymorphisms of Follicle Stimulating Hormone Receptor Gene and Susceptibility to Polycystic Ovary Syndrome: a Meta-analysis