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Published in: Advances in Therapy 11/2019

Open Access 01-11-2019 | Clopidogrel | Original Research

Duration of Dual Antiplatelet Therapy and Late Stent Thrombosis Following Percutaneous Coronary Intervention with Second-Generation Drug-Eluting Stents: A Simple Meta-Analysis of Randomized Controlled Trials

Authors: Bei-you Lin, Ping Li, Peng Wu, Ri-na Jiang, Pravesh Kumar Bundhun, Mohamad Anis Ahmed

Published in: Advances in Therapy | Issue 11/2019

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Abstract

Introduction

The aim of this simple meta-analysis was to systematically compare the occurrence of late and very late stent thrombosis with a short versus a longer duration of dual anti-platelet therapy (DAPT) use following the implantation of second-generation drug-eluting stents (DES).

Methods

Randomized controlled trials that compared short- and long-term DAPT use following percutaneous coronary intervention (PCI) with DES and that reported late (> 30 days but < 1 year) and very late (> 1 year) stent thromboses were searched from the bibliographic database of life sciences and biomedical information, which is also known as MEDLINE, as well as other searched databases including EMBASE, the Cochrane Central and http://​www.​ClinicalTrials.​com. Statistical analysis was carried out using RevMan software [odds ratios (OR) and 95% confidence intervals (CIs) represented the results].

Results

This simple analysis consisted of five randomized controlled trials with a total of 7142 patients. The current results showed no significant difference in late stent thrombosis associated with a shorter or longer duration of DAPT use (OR 0.98, 95% CI 0.30–3.18; P = 0.97, I2 = 0%). The result for very late stent thrombosis was also not significantly different (OR 0.30, 95% CI 0.03–2.95; P = 0.31).

Conclusions

This simple analysis showed no impact of DAPT duration on the occurrence of late and very late stent thrombosis. Similar late and very late stent thrombosis rates were observed with 6-month versus 12-month duration of DAPT use following PCI with second-generation DES.
Literature
1.
go back to reference Zimarino M, Corazzini A, Ricci F, Di Nicola M, De Caterina R. Late thrombosis after double versus single drug-eluting stent in the treatment of coronary bifurcations: a meta-analysis of randomized and observational Studies. JACC Cardiovasc Interv. 2013;6(7):687–95.CrossRef Zimarino M, Corazzini A, Ricci F, Di Nicola M, De Caterina R. Late thrombosis after double versus single drug-eluting stent in the treatment of coronary bifurcations: a meta-analysis of randomized and observational Studies. JACC Cardiovasc Interv. 2013;6(7):687–95.CrossRef
2.
go back to reference Kawecki D, Morawiec B, Dola J, Wanha W, Smolka G, Pluta A, Marcinkiewicz K, Ochała A, Nowalany-Kozielska E, Wojakowski W. First-versus second-generation drug-eluting stents in acute coronary syndromes (Katowice-Zabrze Registry). Arq Bras Cardiol. 2016;106(5):373–81.PubMedPubMedCentral Kawecki D, Morawiec B, Dola J, Wanha W, Smolka G, Pluta A, Marcinkiewicz K, Ochała A, Nowalany-Kozielska E, Wojakowski W. First-versus second-generation drug-eluting stents in acute coronary syndromes (Katowice-Zabrze Registry). Arq Bras Cardiol. 2016;106(5):373–81.PubMedPubMedCentral
3.
go back to reference Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention. 2019;14(14):1435–534.CrossRef Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention. 2019;14(14):1435–534.CrossRef
4.
go back to reference Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Ting HH, O’Gara PT, Kushner FG, Ascheim DD, Brindis RG, Casey DE Jr, Chung MK, de Lemos JA, Diercks DB, Fang JC, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: An update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. J Am Coll Cardiol. 2016;67(10):1235–50.CrossRef Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Ting HH, O’Gara PT, Kushner FG, Ascheim DD, Brindis RG, Casey DE Jr, Chung MK, de Lemos JA, Diercks DB, Fang JC, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: An update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. J Am Coll Cardiol. 2016;67(10):1235–50.CrossRef
5.
go back to reference Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541–619.CrossRef Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541–619.CrossRef
6.
go back to reference Higgins JP, et al. Assessing risk of bias in included studies, in Cochrane handbook for systematic reviews of interventions. Oxford: Wiley; 2008. p. 187–241. Higgins JP, et al. Assessing risk of bias in included studies, in Cochrane handbook for systematic reviews of interventions. Oxford: Wiley; 2008. p. 187–241.
7.
go back to reference Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcareinterventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRef Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcareinterventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRef
8.
go back to reference Han Y, Xu B, Xu K, Guan C, Jing Q, Zheng Q, et al. Six versus 12 months of dual antiplatelet therapy after implantation of biodegradable polymersirolimus-eluting stent: randomized substudy of the I-LOVE-IT 2 trial. Circ Cardiovasc Interv. 2016;9(2):e003145.CrossRef Han Y, Xu B, Xu K, Guan C, Jing Q, Zheng Q, et al. Six versus 12 months of dual antiplatelet therapy after implantation of biodegradable polymersirolimus-eluting stent: randomized substudy of the I-LOVE-IT 2 trial. Circ Cardiovasc Interv. 2016;9(2):e003145.CrossRef
9.
go back to reference Hong SJ, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Her AY, Kim YH, Jang Y, Hong MK; IVUS-XPL Investigators. 6-month versus 12-month dual-antiplatelet therapy following long everolimus-elutingstent implantation: the IVUS-XPL randomized clinical trial. JACC Cardiovasc Interv. 2016;9(14):1438–46. Hong SJ, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Her AY, Kim YH, Jang Y, Hong MK; IVUS-XPL Investigators. 6-month versus 12-month dual-antiplatelet therapy following long everolimus-elutingstent implantation: the IVUS-XPL randomized clinical trial. JACC Cardiovasc Interv. 2016;9(14):1438–46.
10.
go back to reference Lee BK, Kim JS, Lee OH, Min PK, Yoon YW, Hong BK, Shin DH, Kang TS, Kim BO, Cho DK, Jeon DW, Woo SI, Choi S, Kim YH, Kang WC, Kim S, Kim BK, Hong MK, Jang Y, Kwon HM. Safety of six-month dual antiplatelet therapy after second-generation drug-eluting stent implantation: OPTIMA-C Randomised Clinical Trial and OCT Substudy. EuroIntervention. 2018;13(16):1923–30.CrossRef Lee BK, Kim JS, Lee OH, Min PK, Yoon YW, Hong BK, Shin DH, Kang TS, Kim BO, Cho DK, Jeon DW, Woo SI, Choi S, Kim YH, Kang WC, Kim S, Kim BK, Hong MK, Jang Y, Kwon HM. Safety of six-month dual antiplatelet therapy after second-generation drug-eluting stent implantation: OPTIMA-C Randomised Clinical Trial and OCT Substudy. EuroIntervention. 2018;13(16):1923–30.CrossRef
11.
go back to reference Kim BK, Hong MK, Shin DH, Nam CM, Kim JS, Ko YG, Choi D, Kang TS, Park BE, Kang WC, Lee SH, Yoon JH, Hong BK, Kwon HM, Jang Y; RESETInvestigators. A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol. 2012;60(15):1340–8. Kim BK, Hong MK, Shin DH, Nam CM, Kim JS, Ko YG, Choi D, Kang TS, Park BE, Kang WC, Lee SH, Yoon JH, Hong BK, Kwon HM, Jang Y; RESETInvestigators. A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol. 2012;60(15):1340–8.
12.
go back to reference Tarantini G, Nai Fovino L, Tellaroli P, Chieffo A, Barioli A, Menozzi A, et al. Optimal duration of dual antiplatelet therapy after second-generation drug-eluting stentimplantation in patients with diabetes: the SECURITY (Second-Generation Drug-Eluting StentImplantation Followed By Six- Versus Twelve-Month Dual Antiplatelet Therapy)-diabetes substudy. Int J Cardiol. 2016;15(207):168–76.CrossRef Tarantini G, Nai Fovino L, Tellaroli P, Chieffo A, Barioli A, Menozzi A, et al. Optimal duration of dual antiplatelet therapy after second-generation drug-eluting stentimplantation in patients with diabetes: the SECURITY (Second-Generation Drug-Eluting StentImplantation Followed By Six- Versus Twelve-Month Dual Antiplatelet Therapy)-diabetes substudy. Int J Cardiol. 2016;15(207):168–76.CrossRef
13.
go back to reference Bundhun PK, Pursun M, Teeluck AR, Long MY. Are everolimus-eluting stents associated with better clinical outcomes compared to other drug-eluting stents in patients with type 2 diabetes mellitus?: a systematic review and meta-analysis. Medicine (Baltimore). 2016;95(14):e3276.CrossRef Bundhun PK, Pursun M, Teeluck AR, Long MY. Are everolimus-eluting stents associated with better clinical outcomes compared to other drug-eluting stents in patients with type 2 diabetes mellitus?: a systematic review and meta-analysis. Medicine (Baltimore). 2016;95(14):e3276.CrossRef
14.
go back to reference Bundhun PK, Yanamala CM, Huang WQ. Comparing stent thrombosis associated with zotarolimus eluting stents versus everolimus eluting stents at 1 year follow up: a systematic review and meta-analysis of 6 randomized controlled trials. BMC Cardiovasc Disord. 2017;17(1):84.CrossRef Bundhun PK, Yanamala CM, Huang WQ. Comparing stent thrombosis associated with zotarolimus eluting stents versus everolimus eluting stents at 1 year follow up: a systematic review and meta-analysis of 6 randomized controlled trials. BMC Cardiovasc Disord. 2017;17(1):84.CrossRef
15.
go back to reference Krackhardt F, Waliszewski M, Rischner J, Piot C, Pansieri M, Ruiz-Poveda FL, Boxberger M, Noutsias M, Ríos XF, Kherad B. Nine-month clinical outcomes in patients with diabetes treated with polymer-free sirolimus-eluting stents and 6-month vs. 12-month dual-antiplatelet therapy (DAPT). Herz 2019;44(5):433–439.CrossRef Krackhardt F, Waliszewski M, Rischner J, Piot C, Pansieri M, Ruiz-Poveda FL, Boxberger M, Noutsias M, Ríos XF, Kherad B. Nine-month clinical outcomes in patients with diabetes treated with polymer-free sirolimus-eluting stents and 6-month vs. 12-month dual-antiplatelet therapy (DAPT). Herz 2019;44(5):433–439.CrossRef
Metadata
Title
Duration of Dual Antiplatelet Therapy and Late Stent Thrombosis Following Percutaneous Coronary Intervention with Second-Generation Drug-Eluting Stents: A Simple Meta-Analysis of Randomized Controlled Trials
Authors
Bei-you Lin
Ping Li
Peng Wu
Ri-na Jiang
Pravesh Kumar Bundhun
Mohamad Anis Ahmed
Publication date
01-11-2019
Publisher
Springer Healthcare
Published in
Advances in Therapy / Issue 11/2019
Print ISSN: 0741-238X
Electronic ISSN: 1865-8652
DOI
https://doi.org/10.1007/s12325-019-01091-5

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