Shorter DAPT durations provide best balance between efficacy, safety

12 Aug 2021
Dual antiplatelet therapy with cilostazol

Short-term (≤6 months) and shorter durations (≤3 months) of dual antiplatelet therapy (DAPT) reduce the risk of bleeding and are equally effective, with a trend towards lower all-cause mortality independent of coronary artery disease stability, according to the results of a meta-analysis.

Researchers accessed multiple online databases for randomized controlled trials evaluating different DAPT durations—long term (≥12 months) with short term (≤6 months) or shorter term (≤3 months)—in patients with coronary syndromes. The primary endpoint was all-cause mortality. Any bleeding and major bleeding (safety), cardiac death, myocardial infarction, stent thrombosis, revascularization, and stroke (efficacy) were also assessed.

The meta-analysis included 19 trials involving a total of 60,111 patients. DAPT duration ranged from 1 to 24 months, while follow-up duration varied between 9 and 24 months. Of the randomized controlled trials, eight compared shorter-term DAPT (≤3 months) with long-term DAPT (>12 months) in a population of 38,036 patients.

Pooled data revealed that compared with long-term (≥12 months), short-term DAPT (≤6 months) was associated with a tendency towards lower all-cause mortality (risk ratio [RR], 0.90, 95 percent confidence interval [CI], 0.80–1.01) and significant bleeding reduction (major bleeding: RR, 0.68, 95 percent CI, 0.55–0.83; any bleeding: RR, 0.66, 95 percent CI, 0.56–0.77). There were no significant differences in efficacy outcomes.

These observed associations were robust to sensitivity analysis comparing shorter duration DAPT (≤3 months) to long-term DAPT (≥12 months) for all-cause mortality (RR, 0.91, 95 percent CI, 0.79–1.05).

Subgroup analysis showed that short-term DAPT was associated with reduced risk of bleeding in patients with acute or chronic coronary syndromes (RR, 0.66, 95 percent CI, 0.54–0.81 and RR, 0.53, 95 percent CI, 0.33–0.65, respectively), but with higher risk of stent thrombosis in acute coronary syndrome (acute: RR, 1.49, 95 percent CI, 1.02–2.17; chronic: RR, 1.25, 95 percent CI, 0.44–3.58).

The findings suggest that shorter durations of DAPT in patients with acute or chronic coronary syndrome undergoing percutaneous coronary intervention may provide the best balance between efficacy and safety outcomes.

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