Optimal duration of dual antiplatelet therapy after drug eluting stent implantation: a network meta-analysis

Objectives:

There has been much debate regarding the optimal duration of Dual antiplatelet therapy (DAPT) cover after Drug eluting stent (DES) implantation. We aimed to assess the relative benefits between the shorter and longer durations of DAPT coverage.

Methods:

We performed a Network Meta-analysis (NMA) of all the randomized clinical trials (RCT) comparing different time durations of DAPT cover

Results:

We included 11 unique trials with a total of 33458 patients, the longest duration of follow up was 48 months while the shortest was 3 m. Network meta analysis results demonstrated that compared with 12 months, longer DAPT therapy of 30 months reduced the hazard ratio (HR) of stent thrombosis (HR: 0.29, 95% CrI = 0.17 to 0.49). There was no difference in mortality between short and longer durations of DAPT except for 30 vs 48 months (HR 0.48, 95% CrI 0.23 to 0.98). Compared with 12 months, longer DAPT therapy of 30 months reduced the risk of myocardial infarction (HR: 0.47, 95% CrI = 0.37 to 0.61). Results also demonstrated that compared with 12 months, a shorter term DAPT therapy reduced the risk of major bleeding (6 months: HR 0.53: 95% CrI = 0.29-0.98) while longer DAPT therapy increased major bleeding (30 months: HR: 1.61, 95% CrI = 1.21 - 2.15).

Conclusion:

As expected bleeding is less in the shorter duration regimens while the ischemic outcomes are better on the longer duration.