Dual antiplatelet therapy duration and stent type in patients with high bleeding risk: A systematic review and network meta-analysis.

Autor: Saito T; Department of Cardiology, Edogawa Hospital, Tokyo, Japan., Kuno T; Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: kuno-toshiki@hotmail.co.jp., Fujisaki T; Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan., Gupta R; Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT., Hosseini K; Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran., Takagi H; Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan., Wiley J; Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, LA., Bangalore S; Division of Cardiovascular Medicine, New York University Grossman School of Medicine, New York, NY.
Jazyk: angličtina
Zdroj: American heart journal [Am Heart J] 2024 Oct 05; Vol. 279, pp. 9-19. Date of Electronic Publication: 2024 Oct 05.
DOI: 10.1016/j.ahj.2024.10.004
Abstrakt: 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.
Competing Interests: Disclosures Dr. Bangalore is an advisory board member for Abbott Vascular, Boston Scientific, Biotronik, Amgen, Pfizer, Reata, Inari, Truvic, Viatris. The remaining authors have nothing to disclose.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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