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Abbreviated Dual Antiplatelet Therapy Followed by P2Y12 Inhibitor Monotherapy versus 12 Months’ Dual Antiplatelet Therapy Post Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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Abstract

Introduction

An increased incidence of stent thrombosis after implantation of first-generation drug-eluting stents led to a recommendation of dual antiplatelet therapy (DAPT) for 12 months after the procedure. However, given the use of second-generation and newer drug-eluting stents, this recommendation needs to be revisited. Several randomized controlled trials (RCTs) have studied an abbreviated DAPT regimen of ≤ 3 months followed by P2Y12 inhibitor monotherapy, and results have been conflicting.

Objective

We performed a systematic review with meta-analysis of RCTs of abbreviated DAPT for ≤ 3 months followed by P2Y12 monotherapy compared with 12 months of DAPT.

Methods

We performed a systematic search of the MEDLINE/PubMed, Cochrane, and DARE (Database of Abstracts of Reviews of Effects) databases for eligible RCTs. Quantitative analysis was performed based on the intention-to-treat principle. We used the Mantel–Haenszel method with a random-effects model to calculate relative risks (RRs) with 95% confidence intervals (CIs).

Results

The final analysis included four RCTs. We found no difference in the risk of all-cause mortality (RR 0.90; 95% CI 0.77–1.05; p = 0.18; I2 = 0%; χ2p = 0.58), myocardial infarction (RR 0.99; 95% CI 0.86–1.15; p = 0.85; I2 = 0%; χ2p = 0.70), stroke (RR 1.14; 95% CI 0.65–1.98; p = 0.65; I2 = 59%; χ2p = 0.06), or stent thrombosis (RR 0.98; 95% CI 0.73–1.33; p = 0.90; I2 = 0%; χ2p = 0.48). Additionally, there was no difference in the risk for major bleeding, defined as BARC (Bleeding Academic Research Consortium) type 3 or 5, between the two groups (RR 0.62; 95% CI 0.37–1.05; p = 0.07; I2 = 79%; χ2p < 0.05).

Conclusion

Abbreviated DAPT followed by P2Y12 monotherapy resulted in a similar risk of re-ischemic clinical outcomes post percutaneous coronary intervention as compared with the standard 12-month DAPT regimen. The risk of major bleeding (BARC type 3 or 5) also remained similar between the two groups. However, as trials have reported benefits with abbreviated DAPT followed by P2Y12 monotherapy in terms of combined endpoints and all bleeding (BARC type 2–5), additional research is needed.

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Authors and Affiliations

  1. Department of Critical Care Medicine, St John’s Medical College Hospital, Kormangala, Bengaluru, Karnataka, 560034, India

    Ashish Kumar & Mariam Shariff

  2. Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA

    Rajkumar Doshi

  3. Department of Internal Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA

    Igor Pedreira Vaz

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Correspondence to Ashish Kumar.

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Ashish Kumar, Mariam Shariff, Rajkumar Doshi, and Igor Pedreira Vaz have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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Kumar, A., Shariff, M., Doshi, R. et al. Abbreviated Dual Antiplatelet Therapy Followed by P2Y12 Inhibitor Monotherapy versus 12 Months’ Dual Antiplatelet Therapy Post Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Cardiovasc Drugs 20, 355–361 (2020). https://doi.org/10.1007/s40256-019-00390-0

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