1-month dual antiplatelet therapy after Percutaneous Coronary Intervention with Drug eluting stent in High bleeding risk patients: A Pooled analysis
Presenter
Raahat Bansal, MD, Creighton University School of Medicine, Omaha, NE
Abhishek Thandra, MD1, Raahat Bansal, MD2, Rosa Natalia Cruz Torres, MD3, Akshay M Balakrishna1, Navya Reddy Alugubelli, MD1, Aiza Ahmad1, Shiva Ponamgi, MBBS1 and Venkata M Alla, MD4, (1)CHI Health Creighton University Medical Center, Omaha, NE, (2)Creighton University School of Medicine, Omaha, NE, (3)CHI Health Creighton University Medical Center - Bergan Mercy, omaha, NE, (4)Creighton University, Omaha, NE
Keywords: Acute Coronary Syndromes (ACS), Drug-eluting Stent (DES) and Pharmacotherapy
Background
According to ACC/AHA/SCAI recommendations (class IIb) it is reasonable to discontinue dual antiplatelet therapy (DAPT) after 3 months in patients with high bleeding risk (HBR-which includes advance age >75 years, anemia, thrombocytopenia, prior bleeding, chronic NSAID use, etc) who had undergone percutaneous coronary intervention (PCI) with drug eluting stent (DES). We conducted a meta-analysis to establish safety and effectiveness of 1-month DAPT
Methods
PubMed, Google scholar and Cochrane databases were searched for all studies reporting outcomes of 1-month DAPT therapy after PCI with polymer-based DES stents. The primary outcome of interest was 1-year all-cause mortality. Secondary outcomes were 1-year rates of stent thrombosis, myocardial infarction (MI), stroke and target vessel revascularization (TVR). Pooled prevalence with corresponding 95% confidence intervals (CIs) were calculated using random-effects model.
Results
Three studies with 2,385 HBR patients with a mean age of 73 years were included in the pooled analysis. Around 53% of patients included in the analysis presented with ACS. At 1-year follow up, the pooled incidence of all-cause mortality was 7.9% (95% CI: 0.058-0.12) and MI was 6.3% (95% CI: 0.023-0.14). For stent thrombosis, TVR and stroke the calculated pooled incidence was 0.9%, 5% and 1.6% respectively. While, BARC 2-5 bleeding rate was 11.2%. [Figure 1]
Conclusions
Our analysis showed acceptable rates of 1-year mortality in this high-risk population with lower rates of stent thrombosis and TVR. Hence, discontinuation of DAPT after 1-month in patients with HBR is a safe and effective strategy.
