News | Antiplatelet and Anticoagulation Therapies | July 12, 2017

Meta-Analysis Compares Efficacy, Safety of S-DAPT Versus L-DAPT After DES Implantation

long-duration dual anti-platelet therapy (L-DAPT) compared to short-duration dual antiplatelet (S-DAPT) after DES stent implantation

June 12, 2017 — Researchers have evaluated the long-term efficacy and safety of long-duration dual anti-platelet therapy (L-DAPT) compared to short-duration dual antiplatelet therapy (S-DAPT) after drug-eluting stent (DES) implantation. The current meta-analysis is the first to compare outcomes between S-DAPT and L-DAPT in a meta-analysis restricted to trials with patient follow-up of 24 months or longer. The research is detailed in the Editor’s Choice article in the July 2017 issue of Catheterization and Cardiovascular Interventions.

DAPT using a combination of aspirin and a P2Y12 inhibitor is used for the prevention of ischemic complications after DES implantation. It is estimated that more than 10 million DES have been implanted globally, however, the optimal duration of DAPT after DES implantation remains unclear.

“A major limitation of most randomized control trials (RCTs) and previous meta-analyses was a short period of follow-up,” said Abhishek Sharma, M.D., of the Division of Cardiovascular Medicine at State University of New York Downstate Medical Center. “Between the small number of stent thrombosis (ST) events due to the low risk of ST with newer generation DES and the possibility that very-late ST events were not captured due to inadequate follow-up, individual trials and even previous meta-analysis were probably underpowered to detect a definitive difference in reduction of very-late ST with L-DAPT. This limitation was addressed in our study by pooling data from only those RCTs, which have reported outcomes after a follow-up of at least 24 months or longer.”

Researchers identified five RCTs in which 19,760 patients were randomized to S-DAPT (n: 59,810) and L-DAPT (n: 59,950), respectively. Compared with L-DAPT, S-DAPT was associated with higher rate of myocardial infarction (MI) (odds ratio [OR] 1.48, 95% confidence interval (CI) [1.04, 2.10]). There were no significant differences between S-DAPT and L-DAPT in terms of all-cause mortality, cardiac mortality, ST, TVR or stroke (OR 0.90, 95% CI [0.73, 1.12]; OR 1.02, 95% CI [0.80, 1.30]; OR 1.59, 95% CI [0.77, 3.27]; OR 0.87 95% CI [0.67, 1.14]; and OR 1.08 95% CI [0.81, 1.46], respectively). However, rate of thrombolysis in myocardial infarction (TIMI) major bleeding was significantly lower with S-DAPT compared to L-DAPT (OR 0.64, 95% CI [0.41, 0.99]).

“Our results support the importance of carefully choosing DAPT durations based on an individual patient's ischemic and bleeding risks,” Sharma continued. “However, the clinical trials included in the current meta-analysis have mostly used clopidogrel as the second agent. With increasing adoption of more potent P2Y12 inhibitors in clinical practice, the relative benefit-to-risk profile of S-DAPT vs L-DAPT using these agents remains to be established in future studies.”

The authors of “Duration of dual antiplatelet therapy following drug-eluting stent implantation: A systemic review and meta-analysis of randomized controlled trials with longer follow up” include Abhishek Sharma, M.D.; Sahil Agrawal, M.D.; Aakash Garg, M.D.; Ajay Vallakati, M.D.; Carl J. Lavie, M.D.; and Gerald Helft, M.D.

Read the related article "Questions Remain on DAPT Prolongation," insights from trials at ACC 2016.

For more information: www.scai.org/CCI

Related Content

New York Hospital Finds Significant Cost Savings With Toshiba's Aquilion One CT
News | Computed Tomography (CT)| July 25, 2017
July 25, 2017 — In five years, Kaleida Health’s Stroke Care Center (SCC) at the Gates Vascular Institute in Buffalo,
Study Discovers Anticoagulant Drugs Are Being Prescribed Against Safety Advice
News | Antiplatelet and Anticoagulation Therapies| July 25, 2017
July 25, 2017 — A study by researchers at the University of Birmingham has shown that general practitioners (GPs) are
New PET-CT Scan Improves Detection in Rare Cardiac Condition
News | PET-CT| July 25, 2017
Using a new imaging technique that can diagnose cardiac sarcoidosis much more accurately than traditional tests,...
Medtronic Announces First Enrollments in STOP AF First Clinical Trial
News | Ablation Systems| July 24, 2017
Medtronic plc recently announced first enrollments in the STOP AF First clinical trial. The trial will evaluate the...
Hospital Readmissions Analysis Across All Ages, Insurance Types Identifies High-Risk Groups
News | Business| July 20, 2017
July 20, 2017 — Clinician-researchers at Beth Israel Deaconess Medical Center (BIDMC) recently published a first-of-i
3-D Vascular Ultrasound Quantifies Plaque Burden to Estimate Cardiovascular Risk
News | Cardiovascular Ultrasound| July 20, 2017
July 20, 2017 — In a large, first-of-its-kind population, researchers found an experimental technique known as...
More Than 20 Percent of Low-Risk Patients Receive Annual ECG
News | ECG| July 20, 2017
July 20, 2017 — More than one in five Ontario patients receive an ...
Sponsored Content | Videos | CT Angiography (CTA)| July 18, 2017
Matthew Budoff, M.D., FACC, professor of medicine, David Geffen School of Medicine at UCLA, endowed chair of preventi
Low Doses of Radiation Could Harm Cardiovascular Health
News | Radiation Dose Management| July 17, 2017
Ionizing radiation, such as X-rays, has a harmful effect on the cardiovascular system even at doses equivalent to...
First Patient Treated in U.S. Feasibility Study of LimFlow Critical Limb Ischemia Device
News | Peripheral Arterial Disease (PAD)| July 17, 2017
LimFlow SA announced enrollment of the first patient in the U.S. feasibility study of the LimFlow Percutaneous Deep...
Overlay Init