Abstract
Aims Optimal duration of dual antiplatelet therapy (DAPT) in patients with concomitant indication to oral anticoagulation (OAC) is still debated. Methods and results A systematic review was performed on electronic databases to search for randomized controlled trials comparing an abbreviated or prolonged (>= 3 months) DAPT regimen in patients with OAC and they were analysed in the framework of standard and network meta-analyses. Co-primary endpoints were major or clinically relevant non-major bleedings (MCRB) and major bleeding, while the composite of major adverse cardiovascular events (MACE) was the key safety endpoint. Five studies and 7 665 patients (abbreviated DAPT n = 3 843; prolonged DAPT n = 3 822) were included. Both MCRB and major bleeding were lower with abbreviated DAPT [risk ratio (RR) 0.69 (0.52-0.91); P = 0.01 and 0.70 (0.52-0.95); P = 0.01, respectively] while MACE [RR: 0.96 (0.70-1.33); P = 0.6], all-cause death, cardiovascular death, stent thrombosis, or myocardial infarction did not differ. Network meta-analysis showed that peri-procedural DAPT had the highest probability to prevent MCRB and major bleeding (97.1 and 92.0% respectively) when compared with both short (4-6 weeks) and longer (>= 3 months) DAPT regimens. Sensitivity analyses and meta-regressions showed consistency in different clinical scenarios and suggested a larger bleeding reduction with P2Y(12) inhibitors vs. aspirin after DAPT discontinuation. Conclusion In patients undergoing PCI with concomitant OAC indication, an abbreviated DAPT regimen reduced MCRB and major bleeding without increasing MACE or other ischaemic events. Peri-procedural DAPT and P2Y(12) inhibitor monotherapy after DAPT withdrawal appear to be the best strategies to optimize the bleeding and ischaemic risk tradeoff.
Original language | English |
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Article number | pvac065 |
Number of pages | 11 |
Journal | European Heart Journal-Cardiovascular Pharmacotherapy |
DOIs | |
Publication status | E-pub ahead of print - 1 Nov 2022 |
Keywords
- Dual antiplatelet therapy
- Oral anticoagulant therapy
- Percutaneous Coronary Intervention
- Atrial fibrillation
- Aspirin
- P2Y12 inhibitor
- Monotherapy
- TRIPLE ANTITHROMBOTIC THERAPY
- ATRIAL-FIBRILLATION PATIENTS
- ELUTING STENT IMPLANTATION
- VITAMIN-K ANTAGONISTS
- MYOCARDIAL-INFARCTION
- ARTERY-DISEASE
- OPEN-LABEL
- WARFARIN
- ASPIRIN
- CLOPIDOGREL