Meta-analysis of prolonged DAT after DES

Extending the antiaggregation therapy over a year reduces adverse events in patients with a history of AMI, according to this meta-analysis simultaneously published in the European Heart Journal.

They analyzed data from 33.435 patients (mean age 64; 24% women) with a history of infarction included in one of the following clinical trials: CHARISMA, PRODIGY, ARCTIC-Interruption, DAPT, DES-LATE and PEGASUS TIMI-54.

Patients receiving prolonged dual antiaggregation therapy (beyond a year) did better than those than those that continued with aspirin only, as regards primary end point (cardiovascular death, infarction, stroke; RR 0.78; CI 95% 0.67-0.90) and each of its separate components.

However, more severe bleeding was observed with prolonged DAT (prolonged treatment 1.9% vs standard treatment 1.1%; p=0.004); though there were no differences in fatal bleeding, intracranial bleeding or cardiovascular death.

These results were consistent across all pre-specified subgroups, including age, sex, DAT administration, type of ACS, and time after infarction. Patients with an anticoagulation indication were excluded, also patients with a history of bleeding, recent surgeries or a history of intracranial bleeding.

Udell JA.