Duration of Dual Anti-Platelet Therapy After Cardiac Stenting Needs To Be Personalized

MedicalResearch.com Interview with:
Abhishek Sharma MD and

Division of Cardiovascular Medicine State University
New York Downstate Medical Center
Dr.Sahil Agarwal M.B.B.S., M.D.
Division of Cardiology
St. Luke’s University Health Network
Bethlehem, Pennsylvania

MedicalResearch.com: What is the background for this study? 

Response: Prior randomized control trials (RCTs) and meta-analysis of these trials which have attempted to compare differences in outcomes between strategies of short (S) (3-6 months) and longer (L) (12-30 months) durations of dual anti-platelet therapy (DAPT) after drug eluting stents (DES) implantation have reported conflicting results. In general, the events rates in these studies were small, affecting statistical power. To overcome this limitation, we conducted an updated meta-analysis to compare the efficacy and safety of strategies of S-DAPT versus L-DAPT strategy after DES implantation by restricting inclusion to randomized studies with follow-up durations of 24 months or longer.

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. We found no significant difference in the rates of mortality or of stent thrombosis with S-DAPT or L-DAPT. S-DAPT was associated with significantly lower risk of major bleeding but slightly higher risk of future myocardial infarctions.

MedicalResearch.com: What should readers take away from your report?

Response: DAPT therapy needs to be individualized according to individual patient’s bleeding risk and risk of future ischemic events. L-DAPT, which was associated with a lower risk of myocardial infarction should therefore be preferred for patients with high ischemic but low bleeding risk, whilst S-DAPT duration can be safely used in those with high bleeding risk, without risking an increase in mortality or stent thrombosis.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Traditionally, RCTS comparing DAPT strategies have included patients with a spectrum of ischemic and bleeding risks. We would greatly benefit if future trials would restrict enrollment to specific groups of patients, such as those at high risk of future ischemic events (eg. patients treated with DES for an acute coronary syndrome) or those at high bleeding risk etc.

Citation:

Sharma A, Agrawal S, Garg A, Vallakati A, Lavie CJ, GeraldHelft CJ. Duration of dual antiplatelet therapy following drug-eluting stent implantation: A systemic review and meta-analysis of randomized controlled trials with longer follow up. Catheter Cardiovasc Interv. 2017;90:31–37. https://doi.org/10.1002/ccd.27123

 

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