Optimal DAPT Duration in Patients with Coronary Syndromes

Pavankumar Kamat

Disclosures

August 16, 2021

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

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.

 

Bularga A, Meah MN, Doudesis D, Shah ASV, Mills NL, Newby DE, Lee KK. Duration of dual antiplatelet therapy and stability of coronary heart disease: a 60 000-patient meta-analysis of randomised controlled trials. Open Heart. 2021;8(2). doi: 10.1136/openhrt-2021-001707. PMID: 34341097.  View full text

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

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