Metanalysis shows increased risk of bleeding with extended duration of Dual Antiplatelet therapy in PCI patients
The meta-analysis included data from randomised controlled trials investigating the clinical impact of extending DAPT duration in patients undergoing PCI. The primary endpoint was all-cause death. The secondary endpoints were myocardial infarction (MI), stent thrombosis (ST), cerebrovascular accidents (CVAs), and thrombolysis in myocardial infarction (TIMI) major bleeding.
The meta-analysis included data from 4 randomised trials which met inclusion criteria (n=8,231), of whom 50.2% of patients received extended duration DAPT vs. 49.8%, who received standard control duration of DAPT. The median DAPT duration was 16.8 vs. 6.2 months for the extended DAPT and control groups, respectively. The primary endpoint was all-cause death. The secondary endpoints were myocardial infarction (MI), stent thrombosis (ST), cerebrovascular accidents (CVAs), and thrombolysis in myocardial infarction (TIMI) major bleeding.
The authors reported that at follow-up (median 16.8 months) extending DAPT duration did not reduce all-cause death [odds ratio (95% confidence interval) = 1.15 (0.85–1.54), P = 0.36], MI [0.95 (0.66–1.36), P = 0.77], ST [0.88 (0.43–1.81), P = 0.73], or CVAs [1.51 (0.92–2.47), P = 0.10]. Conversely, extended DAPT duration increased the risk of TIMI major bleeding [2.64 (1.31–5.30), P = 0.006].
They conclude that this meta-analysis shows that the extension of DAPT duration after PCI may increase the risk of bleeding without reducing ischaemic events.
