Original title: Meta-analysis of randomized clinical trials comparing short term -vs- long term dual antiplatelet therapy following drug eluting stents. Reference: El-Hayek G et al. Am J Cardiol. 2014; Epub ahead of print.
This meta-analysis examined the data of four randomized and controlled studies (EXCELLENT, PRODIGY, RESET y OPTIMIZE) including 8157 patients receiving sirolimus, paclitaxel, everolimus or zotarolimus DES. Patients were randomized to prolonged antiplatelet therapy (12 to 24 months; n=4076) or double antiagregation for a short period of time (3 to 6 months; n=4081). In all 4 studies, antiagregation was aspirin plus clopidogrel.
At 12 months, MI and cardiac death rates (primary end point) happened in 136 patients (3.3%) in the group of 3 to 6 months antiagregation therapy and in 123 patients (3%) in the 12 to 24 group (OR 1.11, IC 95% 0.87 to 1.43; p=0.41).
Patients receiving the short scheme had a 59% lower risk of major bleeding but with a similar ischemic event rate (OR 0.41, IC 95% 0.21 to 0.81; p=0.01).
Stent thrombosis was more frequent in the short scheme group, yet with no significant statistical importance. (OR 1.29, IC 95% 0.76 to 2.21; p=0.35).
Conclusion
Prolonged therapy with aspirin and clopidogrel after DES significantly increases bleeding risk and does not modify el composite of cardiac death and MI compared to a double antiagregation short scheme.
Editorial Comment
New generations DES have brought light to the requirement of double antiagregation schemes, increasingly perceived as no longer needed, since outcomes depend more on the choice of DES than on prolonged antiagregation therapies.
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