Duration of dual antiplatelet therapy after various drug-eluting stent implantation

Sharma, Abhishek, Sharma, Samin K., Vallakati, Ajay, Garg, Akash, Lavie, Carl J., Mukherjee, Debabrata and Marmur, Jonathan D. (2016) Duration of dual antiplatelet therapy after various drug-eluting stent implantation. International Journal of Cardiology, 215 157-166. doi:10.1016/j.ijcard.2016.04.118


Author Sharma, Abhishek
Sharma, Samin K.
Vallakati, Ajay
Garg, Akash
Lavie, Carl J.
Mukherjee, Debabrata
Marmur, Jonathan D.
Title Duration of dual antiplatelet therapy after various drug-eluting stent implantation
Journal name International Journal of Cardiology   Check publisher's open access policy
ISSN 1874-1754
0167-5273
Publication date 2016-07-15
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.ijcard.2016.04.118
Open Access Status Not Open Access
Volume 215
Start page 157
End page 166
Total pages 10
Place of publication Shannon, Clare Ireland
Publisher Elsevier Ireland
Collection year 2017
Language eng
Formatted abstract
Objective: To evaluate efficacy and safety of long duration dual anti-platelet therapy i.e., > 12 months (L-DAPT) and short duration DAPT i.e., ≤ 12 months (S-DAPT) after various drug-eluting stent (DES) implantation.

Methods: We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) assessing the effect of L-DAPT versus S-DAPT after sirolimus-eluting (Cypher®); paclitaxel-eluting stents (Taxus®); zotarolimus-eluting (Endeavor®) and everolimus-eluting stents (Xience V®) implantation. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using random-effects models. Subgroup analyses were performed comparing two second generation DES and for RCTs comparing S-DAPT and L-DAPT.

Results: We included six RCTs that randomized 19,012 patients to S-DAPT versus L-DAPT (4638 in first generation DES; 14,374 in second generation DES; 8099 EES; 4876 in ZES). Compared with L-DAPT, S-DAPT was associated with a higher rate of myocardial infarction (MI) and stent thrombosis (ST) after first [2.65 (1.88, 3.73) and 3.85 (2.14-6.93) respectively] and a higher rate of MI after second generation DES [1.33 (1.06, 1.67)]. There were no significant differences in the rates of all cause mortality, cardiovascular (CV) mortality and stroke with L-DAPT and S-DAPT after implantation of first [0.97 (0.52, 1.81); 1.19 (0.52-2.70); and 1.12 (0.36-3.52) respectively] and second generation DES [0.93 (0.69, 1.25); 0.93 (0.63, 1.36); and 0.58 (0.19, 1.75), respectively]. On further analysis of type of second generation DES, S-DAPT continues to show a higher rate of MI and ST after EES implantation [1.54 (1.11, 2.13) and 2.68 (1.20-5.94) respectively]; however there was no significant difference in the rate of MI and ST with S-DAPT and L-DAPT after ZES implantation [1.07 (0.44, 2.61) and 1.11(0.39, 3.13), respectively].

Conclusion: 1) Compared with L-DAPT, S-DAPT was associated with a higher rate of MI without any significant difference in the rate of all cause mortality, CV mortality and stroke after first and second generation DES. 2) Rate of ST was also higher with S-DAPT compared to L-DAPT after first generation DES implantation; however, it was not significantly different after second generation DES. 3) On further subgroup analysis of second-generation stent there was no significant difference in the rate of all cause mortality, CV mortality, MI, ST and stroke with S-DAPT and L-DAPT after ZES implantation. S-DAPT may be optimal for newer generation stents particularly ZES.
Keyword Drug-eluting stents
Dual anti-platelet therapy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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