A Meta-Analysis of Duration of Dual antiplatelet therapy in Acute Coronary Syndrome Post Percutaneous Intervention

Background:
Current professional guidelines recommend 12 months of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention in acute coronary syndrome (ACS). While current evidence has shown that shorter duration of DAPT can be non-inferior to ≥12 months DAPT in terms of cardiovascular (CV) outcomes.

Methods:
Ten randomized controlled trials of DAPT comparing shorter duration (3-6 months) with standard duration (12 months) in ACS were included. The primary outcomes were Major adverse cardiovascular events (MACE) composed of myocardial infarction, stroke, revascularization, stent thrombosis and death or Expanded MACE composed of myocardial infarction, stroke, stent thrombosis, death and major bleeding. Outcomes were pooled using generic invariance random effects model. The primary summary measure was hazard ratio (HR) with 95 % confidence interval (CI)

Results:
Four trials contributed MACE data while six trials reported data on expanded MACE (figure). In total of 15,456 patients with ACS, shorter duration of DAPT was non-inferior to standard DAPT (HR, 1.03, 95% CI, 0.83-1.29, P = 0.78) or expanded MACE (HR, 0.97, 95% CI, 0.78, 1.20, P = 0.77 )

Conclusions:
Shorter duration of DAPT was non-inferior to longer duration of DAPT in patients with ACS. Shorter duration of DAPT may be a reasonable alternative approach to avoid higher risk of bleeding associated with prolonged DAPT therapy.