Optimal DAPT Duration in Patients with Coronary Syndromes

Takeaway

• Short-term (≤6 months) and shorter duration (≤3 months) dual antiplatelet therapy (DAPT) were associated with lower risk of bleeding, all-cause mortality and had equivalent efficacy compared with long-term DAPT (≥12 months) in patients with coronary syndromes, irrespective of coronary artery disease stability.

Why this matters

• Findings suggest that shorter durations of DAPT in patients with acute coronary syndrome (ACS) or chronic coronary syndrome undergoing percutaneous coronary intervention may provide the best balance of efficacy and safety outcomes.

Study design

• UK researchers conducted a meta-analysis of 19 randomised controlled trials (RCTs; n=60,111), identified through a literature search across electronic databases.
• Primary outcome: all-cause mortality.
• Secondary outcomes: cardiac death, myocardial infarction, stent thrombosis, coronary revascularisation, stroke (efficacy) and any and major bleeding (safety).
• Funding: British Heart Foundation Research Excellence Award to the University of Edinburgh.

Key results

• Compared with long-term DAPT, short-term DAPT was associated with a lower risk of (relative ratio [RR]; 95% CI):
  • all-cause mortality (0.90; 0.81-1.01);
  • major bleeding (0.68; 0.55-0.83); and
  • any bleeding (0.66; 0.56-0.77).
• No significant differences were seen in efficacy outcomes.
• In sensitivity analysis, shorter duration DAPT vs long-term DAPT was associated with a lower risk of all-cause mortality (RR, 0.91; 95% CI, 0.79-1.05).
• In subgroup analysis, shorter duration DAPT was associated with a lower risk of:
  • all-cause mortality in patients with (RR; 95% CI):
    • ACS (0.94; 0.76-1.16); and
    • chronic coronary syndrome (0.65; 0.39-1.07).
  • major bleeding in patients with (RR; 95% CI):
    • ACS (0.69; 0.50-0.95); and
    • chronic coronary syndrome (0.41; 0.17-0.99).
  • any bleeding in patients with (RR; 95% CI):
    • ACS (0.66; 0.54-0.81); and
    • chronic coronary syndrome (0.53; 0.33-0.65).

Limitations

• Results were based on study-level data.

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.