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

Experimental Vaccine May Reduce Post-Stroke Blood Clot Risk
News | Antiplatelet and Anticoagulation Therapies | November 01, 2018
A vaccine may one day be able to replace oral blood thinners to reduce the risk of secondary strokes caused by blood...
Thrombolytic Science Initiates Phase 2 Trial of Novel Ischemic Stroke Treatment Regimen
News | Antiplatelet and Anticoagulation Therapies | September 07, 2018
A new Phase 2 clinical trial looks to confirm the efficacy and safety of Thrombolytic Science LLC’s (TSI) sequential...
Bleeds and Benefit With Aspirin Balanced in Diabetes Patients
News | Antiplatelet and Anticoagulation Therapies | September 05, 2018
Aspirin prevented serious vascular events in patients with diabetes who did not already have cardiovascular disease,...
Extended Post-Hospital Oral Anticoagulant Use Reduces Non-Fatal Blood Clots
News | Antiplatelet and Anticoagulation Therapies | August 31, 2018
Use of an oral anticoagulant in medically ill patients for 45 days following hospital discharge reduces the rate of non...
AFib Patients Want More Information About Anticoagulation Reversal
News | Antiplatelet and Anticoagulation Therapies | June 27, 2018
Results from a 902-person, five-country survey of people living with atrial fibrillation (AF) reinforce the importance...
Lower Oral DOAC Anticoagulant Use Associated With More Thromboembolic Events Than Warfarin. #HRS 2018
News | Antiplatelet and Anticoagulation Therapies | May 18, 2018
May 18, 2018 — Nearly half of patients prescribed warfarin and just under one third of those using newer direct oral
The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals' Andexxa, the first antidote indicated for patients treated with rivaroxaban (Xarelto) and apixaban (Eliquis), when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding.

The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals' Andexxa, the first antidote indicated for patients treated with rivaroxaban (Xarelto) and apixaban (Eliquis), when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding.

 

Feature | Antiplatelet and Anticoagulation Therapies | May 07, 2018
The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals' Andexxa, the first antidote indicated...
The largest trial to date for short-term DAPT concluded the practice cannot be deemed safe due to a higher adverse event rate. Image courtesy of the American Heart Association. #ACC18

The largest trial to date for short-term DAPT concluded the practice cannot be deemed safe due to a higher adverse event rate. Image courtesy of the American Heart Association.

News | Antiplatelet and Anticoagulation Therapies | March 19, 2018
The combined rate of death from any cause, heart attack or stroke within 18 months was not significantly different in...
The Xarelto booth at ACC.18

The Xarelto booth at the 2018 American College of Cardiology meeting. 

News | Antiplatelet and Anticoagulation Therapies | March 14, 2018
March 14, 2018 — A late-breaking analysis of the landmark COMPASS study presented at the American College of Cardiolo
Overlay Init