Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: a randomized, controlled trial.
نویسندگان
چکیده
BACKGROUND The risks and benefits of long-term dual antiplatelet therapy remain unclear. METHODS AND RESULTS This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinical centers in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011. Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531). The primary end point was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization. At 24 months, the primary end point occurred in 57 aspirin-alone group patients (2.4%) and 61 dual-therapy group patients (2.6%; hazard ratio, 0.94; 95% confidence interval, 0.66-1.35; P=0.75). The 2 groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent thrombosis, or stroke. Major bleeding occurred in 24 (1.1%) and 34 (1.4%) of the aspirin-alone group and dual-therapy group patients, respectively (hazard ratio, 0.71; 95% confidence interval, 0.42-1.20; P=0.20). CONCLUSIONS Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction, or stroke. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01186146.
منابع مشابه
Efficacy and safety of 12 versus 48 months of dual antiplatelet therapy after implantation of a drug-eluting stent: the OPTImal DUAL antiplatelet therapy (OPTIDUAL) trial: study protocol for a randomized controlled trial
BACKGROUND Dual antiplatelet therapy with aspirin and thienopyridine is required after placement of coronary drug-eluting stents (DES) to prevent thrombotic complications. Current clinical guidelines recommend at least 6 to 12 months of treatment after a DES implantation, but it may be beneficial to apply dual antiplatelet therapy for a longer duration. METHODS/DESIGN The optimal dual antipla...
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Background—The optimal duration of dual-antiplatelet therapy and the risk-benefit ratio for long-term dual-antiplatelet therapy after coronary stenting remain poorly defined. We evaluated the impact of up to 6 versus 24 months of dual-antiplatelet therapy in a broad all-comers patient population receiving a balanced proportion of Food and Drug Administration–approved drug-eluting or bare-metal ...
متن کاملOptimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials
ObjeCtive To assess the benefits and risks of short term (<12 months) or extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12 month therapy, following percutaneous coronary intervention with drug eluting stents. Design Meta-analysis of randomised controlled trials. Data sOurCes PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science,...
متن کاملThe optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: chasing a mirage.
T he optimal treatment duration of aspirin and a P2Y12 receptor antagonist after percutaneous coronary intervention (PCI) has vexed cardiologists since the introduction of drug-eluting stents (DES) approximately a decade ago. A short (2to 4-week) course of aspirin and a thienopyridine after elective implantation of a bare-metal stent became the standard of care by default from randomized trials...
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The objective of this article is to review the contemporary literature on optimal dual antiplatelet therapy (DAPT) duration after drug-eluting stent (DES) implantation. Relevant studies were searched through MEDLINE, the Cochrane database, and the EMBASE database. Of the 6852 publications retrieved, 23 were considered relevant, including 11 randomized controlled trials (RCTs) and 12 meta-analys...
متن کاملIndividualization of dual antiplatelet therapy duration after drug-eluting stent implantation: paradigm and reality.
The use of drug-eluting stents (DES) results in a dramatic reduction in restenosis and represents one of the major advances in interventional cardiology. Yet, a reduction in death and myocardial infarction could not be shown with these devices; instead there were concerns about an excess of late thrombotic events compared with bare metal stents (BMS). The key underlying pathophysiological mecha...
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عنوان ژورنال:
- Circulation
دوره 129 3 شماره
صفحات -
تاریخ انتشار 2014