Wednesday, October 24, 2012

Meta-analysis: Extended dual antiplatelet therapy after PCI increases risk of bleeding without reducing ischaemic events

Metanalysis shows increased risk of bleeding with extended duration of Dual Antiplatelet therapy in PCI patients
According to a meta-analysis published early online in the European Heart Journal, the extension of dual antiplatelet therapy (DAPT) duration after percutaneous coronary interventions (PCI) may increase the risk of bleeding without reducing ischaemic events.

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.