Review: Short vs. long duration dual antiplatelet Tx after stent

(HealthDay)—Dual antiplatelet therapy (DAPT) continued beyond six months after drug-eluting stent implantation is associated with reduced stent thrombosis and myocardial infarction but also increased bleeding and all-cause mortality as compared to shorter-term DAPT therapy, according to a review published online May 25 in Cardiovascular Therapeutics.

Elsayed Abo-salem, M.D., from the University of Cincinnati, and colleagues conducted a systematic literature review to compare continued use of DAPT with shorter duration DAPT (aspirin alone) for variable durations beyond three months of drug-eluting stent implantation. Data were included from 10 randomized controlled trials involving 32,136 subjects randomized to continued use of DAPT versus aspirin alone.

The researchers found that longer DAPT correlated with a significant reduction in stent thrombosis (0.3 versus 0.7 percent; P < 0.01) and myocardial infarction (1.3 versus 2 percent; P < 0.01) compared with shorter DAPT. Longer DAPT was also associated with a significant increase in major bleeding versus shorter DAPT (0.8 versus 0.4 percent; P < 0.01). No difference was seen in cardiac deaths or stroke. Compared with longer DAPT, shorter DAPT correlated with slightly lower all-cause mortality (odds ratio, 0.8; 95 percent confidence interval, 0.7 to 0.99; P = 0.04).

"DAPT continued beyond six months after second generation drug-eluting stent implantation decreases stent thrombosis and myocardial infarction, but increases major bleeding and all-causes mortality compared to shorter DAPT (aspirin alone)," the authors conclude.