Long duration dual antiplatelet treatment increases bleeding

(HealthDay)—Routine use of dual antiplatelet therapy (DAPT) beyond six months after second generation drug-eluting stent (DES) implantation yields mixed clinical results, according to a review published in the October issue of Cardiovascular Therapeutics.

Elsayed Abo-salem, M.D., from the University of Cincinnati, and colleagues conducted a systematic literature search to identify randomized controlled trials (RCTs) comparing the continued use of DAPT with shorter duration of DAPT (aspirin alone) for variable durations beyond three months after DES implantation.

The researchers identified 10 RCTs with 32,136 subjects randomized to continued use of DAPT versus aspirin alone for variable durations after three months of DES implantation. The studies were not significant heterogeneously. Longer DAPT resulted in a significant reduction in stent thrombosis (P < 0.01) and myocardial infarction (P < 0.01), and a significant increase in major bleeding (P < 0.01), compared to shorter DAPT. Cardiac deaths or stroke did not differ by DAPT length. With shorter DAPT, all-cause deaths were slightly lower, compared to longer DAPT (odds ratio, 0.8; P = 0.04).

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

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