Efficacy and safety of short-term (≤6 months) duration of dual antiplatelet therapy after drug-eluting stents: a meta-analysis of randomized controlled trials

Objective Optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation remains controversial. The present study is an assessment of efficacy and safety of short-term (≤6 months) DAPT after DES implantation in patients with coronary artery disease, especially in important subgroups. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized, controlled trials comparing short-term and long-term (>6 months) DAPT after DES implantation. Primary efficacy outcome was stent thrombosis (ST). Primary safety outcome was major bleeding. Pooled relative risks (RRs) with 95% confidence interval (CI) were calculated using random- or fixed-effects models as appropriate. Results Total of 7 trials involving 15870 patients were included in the study. Short-term DAPT significantly reduced major bleeding by 49% compared with long-term DAPT (RR: 0.51; 95% CI: 0.32-0.80; p=0.003) without increasing risk of ST (RR: 1.28; 95% CI: 0.83-1.97; p=0.266). In addition, no differences were observed in all-cause mortality, myocardial infarction (MI), cardiac mortality, or cerebrovascular accidents. Moreover, no significant difference in composite of cardiovascular events, bleeding, and mortality was found in important clinical subgroups. Conclusion Short-term DAPT is associated with lower bleeding risk compared with long-term DAPT. Number of ST and MI was higher with short-term DAPT without reaching statistical significance. Comprehensive clinical judgment is necessary to weigh benefits and risks in the individual patient.