Open AccessShort versus prolonged dual antiplatelet therapy (DAPT) duration after coronary stent implantation: A comparison between the DAPT study and 9 other trials evaluating DAPT duration
Author(s) -
Toshiaki Takahashi,
Hiroki Shiomi,
Takeshi Morimoto,
Masahiro Natsuaki,
Takeshi Kimura
Publication year - 2017
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0174502
Subject(s) - medicine , aspirin , cardiology , odds ratio , myocardial infarction , coronary stent , drug eluting stent , clopidogrel , stent , percutaneous coronary intervention , restenosis
Aims The Dual Antiplatelet Therapy (DAPT) study demonstrated that DAPT beyond 1-year after drug-eluting stent (DES) implantation, as compared with aspirin therapy alone, significantly reduced the risk of major cardiovascular and cerebrovascular events, which was mainly driven by the large risk reduction for myocardial infarction (MI). We sought to compare the largest DAPT study with other trials evaluating DAPT durations after DES implantation. Methods and results By a systematic literature search, we identified 9 trials comparing prolonged- versus short-DAPT in addition to the DAPT study. The result from the DAPT study (N = 9961) with public–private collaboration was different from the pooled result of the 9 other investigator-driven trials (N = 22174) in terms of the effect of prolonged-DAPT on MI (odds ratio [OR] 0.48 [95%CI 0.38–0.62] versus pooled OR 0.88 [95%CI 0.67–1.15]: P = 0.001 for difference), while the trends for excess risk of prolonged-DAPT relative to short-DAPT for all-cause death (OR 1.31 [95%CI 0.97–1.78] versus pooled OR 1.16 [95%CI 0.92–1.45]: P = 0.53 for difference), and bleeding (OR 1.62 [95%CI 1.21–2.17] versus pooled OR 2.08 [95%CI 1.51–2.84]: P = 0.25 for difference) were consistently seen in both the DAPT and other trials. The annual rate of MI during aspirin mono-therapy in the DAPT study was much higher than that those in the other trials (2.7% versus 0.6–1.6%). Conclusions Given the difference between the DAPT study and other trials, future studies should focus on certain subgroups of patients that are more or less likely to benefit from longer duration DAPT.