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Dual Antiplatelet Therapy Duration and Stent Type in Patients With High Bleeding Risk: A Systematic Review and Network Meta-Analysis Publisher Pubmed



Saito T1 ; Kuno T2, 3, 4 ; Fujisaki T5, 6 ; Gupta R7 ; Hosseini K8 ; Takagi H9 ; Wiley J10 ; Bangalore S11
Authors
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Authors Affiliations
  1. 1. Department of Cardiology, Edogawa Hospital, Tokyo, Japan
  2. 2. Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
  3. 3. Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
  4. 4. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
  5. 5. Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
  6. 6. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
  7. 7. Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
  8. 8. Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  9. 9. Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
  10. 10. Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States
  11. 11. Division of Cardiovascular Medicine, New York University Grossman School of Medicine, New York, NY, United States

Source: American Heart Journal Published:2025


Abstract

Background: It is uncertain whether the efficacy and safety of dual antiplatelet therapy (DAPT) in patients with high bleeding risk (HBR) vary according to DAPT duration and stent type (eg, durable polymer drug-eluting stents (DP-DESs), biodegradable polymer DESs (BP-DESs), or polymer-free drug-coated stents (PF-DCSs)). We aimed to study the stent type and DAPT duration appropriate for patients with HBR. Methods: PubMed and EMBASE were searched until October 2023. Randomized controlled trials (RCTs) involving patients with HBR that compared standard DAPT (6-12 months) with DP- or BP-DES versus short DAPT (≤3 months) with DP- or BP-DES or PF-DCS or bare-metal stent (BMS) were identified. The primary efficacy outcome was major adverse cardiovascular events (MACEs), defined as cardiovascular death, myocardial infarction (MI), and stroke. The primary safety outcome was major bleeding. Secondary outcomes included MI and stent thrombosis (ST). We performed a network meta-analysis using a random effects model. Results: Thirteen RCTs with a total of 19,418 patients with HBR were included. Compared to standard DAPT with DP-DES, short DAPT with BMS was associated with a higher risk of MACE and MI. For major bleeding, short DAPT strategies were associated with a lower risk than standard DAPT strategies (e.g. short DAPT with DP-DES vs standard DAPT with DP-DES; HR[95% CI]: 0.48[0.28-0.82]). Interestingly, the use of BP-DES was associated with a higher risk of ST than DP-DES (e.g. standard DAPT with BP-DES vs short DAPT with DP-DES; HR[95% CI]: 2.65[1.03-6.79]). Conclusions: In patients with HBR who underwent percutaneous coronary intervention, a short DAPT strategy with DP-DES should be used since it offers the best combination of efficacy and safety. © 2024 Elsevier Inc.