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Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet Therapy After Coronary Stenting
- Source :
- Journal of the American College of Cardiology, Journal of the American College of Cardiology, 2017, 69 (16), pp.2011-2022. ⟨10.1016/j.jacc.2017.02.029⟩
- Publication Year :
- 2017
-
Abstract
- Background Although some randomized controlled trials (RCTs) and meta-analyses have suggested that prolonged dual-antiplatelet therapy (DAPT) may be associated with increased mortality, the mechanistic underpinnings of this association remain unclear. Objectives The aim of this study was to analyze the associations among bleeding, mortality, and DAPT duration after drug-eluting stent implantation in a meta-analysis of RCTs. Methods RCTs comparing different DAPT durations after drug-eluting stent placement were sought through the MEDLINE, Embase, and Cochrane databases and the proceedings of international meetings. Deaths were considered possibly bleeding related if occurring within 1 year of the episodes of bleeding. Primary analysis was by intention-to-treat. Secondary analysis was performed in a modified intention-to-treat population in which events occurring when all patients were on DAPT were excluded. Results Individual patient data were obtained for 6 RCTs, and aggregate data were available for 12 RCTs. Patients with bleeding had significantly higher rates of mortality compared with those without, and in a time-adjusted multivariate analysis, bleeding was an independent predictor of mortality occurring within 1 year of the bleeding episode (hazard ratio: 6.93; 95% confidence interval: 4.53 to 10.60; p< 0.0001). Shorter DAPT was associated with lower rates of all-cause death compared with longer DAPT (hazard ratio: 0.85; 95% confidence interval: 0.73 to 1.00; p= 0.05), which was driven by lower rates of bleeding-related deaths with shorter DAPT compared with prolonged DAPT (hazard ratio: 0.65; 95% confidence interval: 0.43 to 0.99; p= 0.04). Mortality unrelated to bleeding was comparable between the 2groups. Similar results were apparent in the modified intention-to-treat population. Conclusions Bleeding was strongly associated with the occurrence of mortality within 1 year after the bleeding event. Shorter compared with longer DAPT was associated with lower risk for bleeding-related death, a finding that mayunderlie the lower all-cause mortality with shorter DAPT in the RCTs of different DAPT durations after DES.
- Subjects :
- medicine.medical_specialty
Multivariate analysis
animal structures
[SDV]Life Sciences [q-bio]
medicine.medical_treatment
Population
MEDLINE
Hemorrhage
030204 cardiovascular system & hematology
Lower risk
law.invention
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Randomized controlled trial
law
Internal medicine
medicine
Drug-Eluting Stent
drug-eluting stent
dual antiplatelet therapy
030212 general & internal medicine
dual antiplatelet therapy
mortality
drug-eluting stents
hemorrhage
humans
percutaneous coronary intervention
platelet aggregation inhibitors
postoperative complications
randomized controlled trials as topic
cardiology and cardiovascular medicine
education
Randomized Controlled Trials as Topic
education.field_of_study
business.industry
Platelet Aggregation Inhibitor
Hazard ratio
Confidence interval
Surgery
[SDV] Life Sciences [q-bio]
Drug-eluting stent
Postoperative Complication
business
Cardiology and Cardiovascular Medicine
Human
Subjects
Details
- Language :
- English
- ISSN :
- 07351097 and 15583597
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology, Journal of the American College of Cardiology, 2017, 69 (16), pp.2011-2022. ⟨10.1016/j.jacc.2017.02.029⟩
- Accession number :
- edsair.doi.dedup.....e30cc4552abaef987d1ad2490ae2a003