Dual antiplatelet therapy duration after percutaneous coronary intervention in patients with indication to oral anticoagulant therapy. A systematic review and meta-analysis of randomized controlled trials
Authors' conclusion
In patients undergoing PCI with concomitant OAC indication, an abbreviated DAPT regimen reduced MCRB and major bleeding without increasing MACE or other ischaemic events.
Study context
- Population
- Patients with oral anticoagulation (OAC) indication undergoing PCI
- Participants
- 7,665 patients5 studies
- Comparison
- Abbreviated vs prolonged DAPT
- Abbreviated DAPTn = 3,843
- Prolonged DAPTn = 3,822reference
- Outcome
- Co-primary: major or clinically relevant non-major bleeding (MCRB) and major bleeding
Methodological detailsstandard and network meta-analyses
- Standard and network meta-analyses
Pooled result
As reported in the abstract
Abbreviated DAPT vs Prolonged DAPTRelative risk (CI)P value
MCRB
0.69(0.52–0.91)
P = 0.01Major bleeding
0.70(0.52–0.95)
P = 0.01Further pooled results
MCRB and major bleeding, network meta-analysis
- Peri-procedural DAPT had highest probability to prevent MCRB vs short (4-6 weeks) and longer (≥3 months) DAPT
- 97.1
- Peri-procedural DAPT had highest probability to prevent major bleeding
- 92.0%
Sensitivity analyses and meta-regressions
- Consistency across clinical scenarios; larger bleeding reduction with P2Y12 inhibitors vs aspirin after DAPT discontinuation suggested
All-cause death, CV death, stent thrombosis, MI
- Did not differ
Safety
| Outcome | RR (CI) | P value | |
|---|---|---|---|
| MACE (key safety endpoint) | 0.96 (0.70–1.33) | P = 0.6 | |
| 0.512Relative risk (log scale) |
Original publication
Dual antiplatelet therapy duration after percutaneous coronary intervention in patients with indication to oral anticoagulant therapy. A systematic review and meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother. Published 25 November 2022. doi:10.
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