Different durations of dual anti-platelet therapy after percutaneous coronary intervention with drug-eluting stents in patients with coronary disease: A systematic review / 中国药学杂志

ABSTRACT

OBJECTIVE: To evaluate the benefits and risks of different durations of dual anti-platelet therapy after percutaneous coronary intervention with drug-eluting stent in patients with coronary disease. METHODS: PubMed, Embase, Cochrane Library, CBM, CNKI, VIP, Wanfang Data, Clinical Trials and ICTRP were searched for randomized controlled trials(RCTs) comparing different DAPT durations after PCI with DES in patients with coronary disease. Risk of bias was assessed with the tool recommended by Cochrane Collaboration. Network Meta-analysis was performed with WinBUGS 1.4.3 and ST ATA 12.0. RESULTS: A total of 3 230 articles were found and 10 RCTs including 31 643 patients were systematically reviewed. Network Meta-analysis showed there was no significantly difference among the 6 different durations in the rates of stent thrombosis, myocardial infarction, all-cause mortality and major bleeding, except that the durations of 6 months [OR 10.56, 95% CI(1.62, 9.17)] and 12 months [OR 4.05, 95% CI(1.01, 11.46)] were different with 30 months in the rate of stent thrombosis. Ranking of cumulative probabilities showed that 30 months and 36 months of DAPT had the lowest risk of stent thrombosis and myocardial infarction, meanwhile duration of 3 months and 6 months had the lowest risk of all-cause mortality and major bleeding. CONCLUSION: Clinicians should assess the risks of stent thrombosis and bleeding according to patient's individual condition and determine the optimal duration of DAPT. It is considered feasible to appropriately extend the duration of DAPT in patients at lower bleeding risk.