Coronary disease, after stent implantation: Optimal duration of dual antiplatelet therapy
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2014 Dec 4;371(23):2155-66 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
dual antiplatelet therapy (aspirin + P2Y12 inhibitor (clopidogrel or prasugrel)) for 30 months
As Treatment, Chronic
Is worse Than
dual antiplatelet therapy (aspirin + thienopyridine) for 12 months only
To improve all-cause mortality (2.0% 30 months VS 1.5% 12 months), even if it reduced cardiovascular events (4.3% 30 months VS 5.9% 12 months). Extended treatment increased major bleedings (2.5% vs 1.6%) but that did not explain the mortality difference
N Engl J Med. 2015 May 07;372(19):1791-800 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
mantaining dual antiplatelet after 1 year with ticagrelor (90 mg twice daily or 60 mg twice daily) plus low-dose aspirin
As Treatment, Chronic
Is better Than
placebo plus low-dose aspirin
To reduce cardiovascular events (8% both doses ticagrelor VS 9% aspirin alone) but increasing major bleeding (2.5% ticagrelor VS 1% aspirin alone)
J Am Coll Cardiol. 2015 Mar 24;65(11):1092-102 Meta-Analysis
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
short- (≤6 months) dual antiplatelet therapy
As Treatment, Chronic
Is better Than
long-term (1 year) dual antiplatelet therapy
To reduce bleeding (HR 0.66) while achieving similar rates of cardiac events (cardiac death, myocardial infarction, or definite/probable stent thrombosis: HR 1.11)
BMJ. 2015 Apr 16;350:h1618 Meta-Analysis
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
short term course of dual antiplatelet therapy
As Treatment, Chronic
Is better Than
12 month dual antiplatelet therapy
To reduce major bleeding (OR 0.58) with no significant differences in ischaemic or thrombotic outcomes. Extended VS 12 month Tt yielded a reduction of ischemic events (OR 0.33 to 0.53) but more major bleeding (OR 1.66) and more all-cause deaths (OR 1.30)