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Efficacy and Safety of Using 3 vs 12-Month Antiplatelet Therapy After Percutaneous Coronary Intervention: Meta-Analysis of Randomized Controlled Clinical Trials
Session:
Sessão de Posters 36 - Antiagregação plaquetar
Speaker:
Ana Filipa Mesquita Gerardo
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Filipa Mesquita Gerardo; Mariana Passos; Inês Fialho; Carolina Mateus; Inês Miranda; Joana Lima Lopes; Mara Sarmento; Pedro Custódio; Daniel Faria
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Background: The optimal duration of dual antiplatelet therapy (DAPT) in the era of second generation drug-eluting stents is a matter of debate as increasing evidence suggests that shorter periods of DAPT are feasible and reduce bleeding events. However, the non-inferiority design of the published trials regarding ischemic events still raises doubt on its effectiveness. </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Methods: We performed a meta-analysis to evaluate short-term (≤ 3 months) vs long-term (≥ 12 months) DAPT after percutaneous coronary intervention (PCI). PubMed, Embase and Cochrane Central were searched from inception to February 2023 to identify randomized controlled trials that compared outcomes of patients between these two regimens. Primary outcome of interest included a composite of ischemic events (cardiovascular [CV] death, myocardial infarction, re-revascularization and stroke) and secondary outcome was major bleeding as assessed by Bleeding Academic Research Consortium (BARC) classification ≥ 3 after 1 year of follow up. Event rates were extracted and Mantel-Haenszel fixed-effects model was used to perform the meta-analysis.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Results: We identified a total of 5 trials with 18.682 randomized patients. <span style="color:black">The included studies were: 1) The effect of 1-month DAPT followed by clopidogrel vs 12-Month DAPT on cardiovascular and bleeding events in patients receiving PCI (STOPDAPT-2) trial; 2) The comparison of clopidogrel monotherapy after 1 to 2 Months of DAPT with 12 months of DAPT in patients with acute coronary syndrome (ACS) (STOPDAPT-2 ACS) trial; 3) The effect of ticagrelor monotherapy vs ticagrelor with aspirin on major bleeding and CV events in patients with ACS (TICO) trial; 4) The randomized evaluation of short-term DAPT in patients with ACS treated with a new-generation stent (REDUCE) trial and 5) The ticagrelor with or without aspirin in high-risk patients after PCI (TWILIGTH) trial.</span> <span style="color:black">All 5 studies contributed to the outcome of BARC-defined major bleeding. In the pooled analysis, the use of ≤3-month DAPT was associated with a 26% reduction in major bleeding (HR 0.74, 95% CI 0.65 to 0.84, p<0.01, I<sup>2</sup>=0%). Ischemic outcomes were similar for ≤3-month-DAPT and ≥12-month-DAPT (HR 0.90, 95% CI 0.75-1.08, p=0.25, I<sup>2</sup>=27%) (figure 1).</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Conclusion: The present meta-analysis provides an updated data on the use of DAPT duration. Short-term DAPT appears to be equivalent to long-term DAPT regarding ischemic risk and a superior strategy in optimizing bleeding risk reduction. </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p>
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