Duration of dual antiplatelet therapy after drug-eluting stent implantation: Meta-analysis of large randomised controlled trials

Patients receive dual antiplatelet therapy (DAPT) for 6-12 months after drug-eluting stents (DES) implantation. The efficacy and safety of prolonged DAPT has been questioned. Therefore, we performed a meta-analysis on randomised trials comparing different DAPT durations. Literature was searched on trials comparing different DAPT durations. For inclusion, reports must report frequency of cardiovascular and bleeding events. Ten trials were included. Compared to 12 months, DAPT beyond 12 months was associated with fewer myocardial infarctions (OR 0.58 95%CI: 0.40-0.84) and stent thrombosis (OR 0.35 95%CI: 0.20-0.62), but more major bleeds (OR 1.60 95%CI: 1.22-2.11) and all-cause (OR 1.30 95%CI: 1.02-1.66) mortality. There was no significant alteration in risk of stroke (OR 0.93 95%CI: 0.66-1.31) or cardiac (OR 1.12 95%CI: 0.73-1.71) mortality. Compared to less than 12 months DAPT, 12 months DAPT did not reduce risk of myocardial infarction, stent thrombosis, strokes, cardiac or all-cause mortality, but increased the risk of major bleeds (OR 1.60 95%CI: 1.22-2.11). DAPT beyond 12 months reduce risk of myocardial infarction and stent thrombosis, but there is substantial increase in major bleeding risk and all-cause mortality which need to be addressed. DAPT beyond 12 months does not appear to alter the risk of stroke.