Efficacy And Safety Of Short-term Versus Standard Dual Antiplatelet Therapy In Patients Undergoing Percutaneous Coronary Intervention: A Meta-analysis

Background and objective:Patients undergoing percutaneous coronary intervention are recommended to take standard dual antiplatelet therapy for 12 months,which is based on the previous research data.With the application of new generation stents and new antiplatelet drugs,reducing bleeding with shortening the duration of dual antiplatelet therapy is more important than attempting further reduction the risk of ischemic events by prolonging the duration of dual antiplatelet therapy.The optimal duration of dual antiplatelet therapy after percutaneous coronary intervention remains controversial at present.The purpose of this meta-analysis was to investigate the efficacy and safety of short-term dual antiplatelet therapy in patients undergoing percutaneous coronary intervention.Methods:Pub Med,Embase,Cochrane Library and Web of science from inception to September 2019 were systematically searched.Randomized controlled trials were included to compare short-term(three months or less)with standard12-months dual antiplatelet therapy in patients undergoing percutaneous coronary intervention.Efficacy endpoints included mortality outcomes(all-cause and cardiovascular deaths),and ischemic outcomes(myocardial infarction,defined or probable stent thrombosis,and stroke).Safety endpoints included major bleeding and any bleeding.The risk ratio(RR)and 95%confidence interval(CI)of each end point were calculated by using Rev Man 5.3 software according to random effects model or fixed effects model.State 12.0 software was used for subgroup analysis and sensitivity analysis.Trial Sequential Analysis Version 0.9.5.10 software was used to calculate the sample size required for each endpoint to achieve a statistically significant difference.Results:This meta-analysis included 38,479 patients with stent implanted from eight randomized clinical trials.No difference was observed in the risk of all-cause death(2.1%vs 2.3%,RR 0.92,0.80–1.06,P=0.25,I~2=0%,P Heterogeneity=0.62),cardiovascular death(1.1%vs 1.2%,RR 0.88,0.69–1.12,P=0.29,I~2=0%,P Heterogeneity=0.79),myocardial infarction(2.8%vs 2.6%,RR 1.05,0.94–1.19,P=0.38,I~2=0%,P Heterogeneity=0.49),definite or probable stent thrombosis(0.6%vs 0.6%,RR1.05,0.80–1.36,P=0.73,I~2=0%,P Heterogeneity=0.60),and stroke(0.7%vs 0.7%,RR1.02,0.80–1.30,P=0.89,I~2=25%,P Heterogeneity=0.24)between short-term(1-3months)and standard(12 months)dual antiplatelet therapy.The short-term dual antiplatelet therapy could reduce the risk of major bleeding(1.4%vs 1.8%,RR 0.67,0.48–0.94,P=0.02,I~2=62%,P Heterogeneity=0.01)and any bleeding(3%vs 4.9%,RR0.63,0.48–0.82,P=0.0005,I~2=52%,P Heterogeneity=0.08).Conclusions:Compared with standard dual antiplatelet therapy,short-term antiplatelet therapy significantly reduces the risk of bleeding without increasing the risk of death or ischemia.However,shortening the duration of dual antiplatelet therapy should be individualized according to the ischemic and bleeding risks of patients.The study protocol was registered in PROSPERO(CRD42020153881).