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Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis

Selected in The Lancet by R. Dworakowski

References

Authors

Sammy Elmariah, Laura Mauri, Gheorghe Doros, Benjamin Z Galper, Kelly E O'Neill, Prof Philippe Gabriel Steg, Prof Dean J Kereiakes, Dr Robert W Yeh

Reference

Lancet, 385(9970), 792–798

Published

February 2015

Link

Read the article

My Comment

What is known

In patients at high risk of ischaemic events, dual antiplatelet therapy might prevent potentially fatal thrombotic events but data are conflicting. A recently published DAPT Study suggests that extended use of dual antiplatelet therapy reduces death, myocardial infarction, and stroke at 30 months for the price of increased all-cause mortality.

Major findings

  • 14 eligible trials that randomly assigned 69 644 participants to different durations of dual antiplatelet therapy
  • compared with aspirin alone or short duration dual antiplatelet therapy (≤6 months), continued treatment was not associated with a difference in all-cause mortality (hazard ratio [HR] 1.05, 95% credible interval [CrI] 0.96–1.19; p=0.33)
  • cardiovascular (1.01, 0.93–1.12; p=0.81) and non-cardiovascular mortality (1.04, 0.90–1.26; p=0.66) were no different with extended duration versus short duration dual antiplatelet therapy or aspirin alone.
  • extended duration dual antiplatelet therapy was not associated with a difference in the risk of all-cause, cardiovascular, or non-cardiovascular death compared with aspirin alone or short duration dual antiplatelet therapy.

My comments

This study provides some reassurance about extended use of dual antiplatelet therapy but does not support it as well. However dual antiplatelet therapy can reduce the risk of thromboembolic events, the risks of adverse events exist and could outweigh benefits, so that overall mortality is unchanged or even increased. Extending dual antiplatelet therapy over 12 months might be considered but balance of risk and benefits should be tailored for individual patient.

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