Study supports short term DAPT after PCI in patients with Drug-eluting stent

The ideal timing of switching from DAPT to a single antiplatelet treatment after percutaneous coronary intervention remains a matter of discussion. A new meta-analysis published in BMJ supports short term Dual Antiplatelet Therapy (DAPT) after the percutaneous coronary intervention (PCI) of patients with a drug-eluting stent (DES).

The study aimed at evaluating the efficacy and safety of standard term (12 months) or long term (>12 months) dual antiplatelet therapy (DAPT) versus short term (<6 months) DAPT after the percutaneous coronary intervention (PCI) with drug-eluting stent (DES).

To achieve the same a systematic review and network meta-analysis was conducted wherein randomized controlled trials comparing two of the three durations of DAPT (short term, standard term, and long term) after PCI with DES were included. The primary study outcomes were cardiac or non-cardiac death, all-cause mortality, myocardial infarction, stent thrombosis, and all bleeding events.

key findings

• Compared with short term DAPT, network meta-analysis showed that long term DAPT resulted in higher rates of major bleeding and non-cardiac death


• Standard term DAPT was associated with higher rates of any bleeding.


• No noticeable difference was observed in other primary endpoints.


• The sensitivity analysis revealed that the risks of non-cardiac death and bleeding were further increased for ≥18 months of DAPT compared with short term or standard term DAPT.


• In the subgroup analysis, long term DAPT led to higher all-cause mortality than short term DAPT in patients implanted with newer-generation DES


• Short term DAPT presented similar efficacy and safety to standard term DAPT with acute coronary syndrome (ACS) presentation and newer-generation DES placement.

The study confirmes that in patients with all clinical presentations, compared with short term DAPT (clopidogrel), long term DAPT may lead to higher rates of major bleeding and non-cardiac death, and standard term DAPT could be associated with an increased risk of any bleeding.

Furthermore, for patients with ACS, short term DAPT presented similar efficacy and safety with standard term DAPT.In a subanalysis of patients receiving newer-generation stents, long-term DAPT conferred increased risks for all-cause mortality, major bleeding, and any bleeding.

The researchers conclude that short term DAPT (with clopidogrel) could be considered for most patients after percutaneous coronary intervention(PCI)with DES.

For more reference, please click on the link: doi: https://doi.org/10.1136/bmj.l2222