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Got It, Hide thisAfter drug-coated stents are placed in heart arteries, use of 2 drugs for 1 year or less reduces deaths compared with longer use
Palmerini T, Benedetto U, Bacchi-Reggiani L, et al. Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials. Lancet. 2015; 385:2371-82
Review question
After people with coronary heart disease have drug-coated stents placed in the heart arteries, should 2 antiplatelet drugs be used together for a longer or shorter time?
Background
In people with coronary heart disease, arteries in the heart become narrowed or blocked. Putting stents in the arteries can open them up, and coating the stents with drugs (drug-eluting stents) can help keep blockages from coming back. However, stents can cause blood clots, which can cause strokes and heart attacks. Antiplatelet drugs help prevent blood clots, but can also cause bleeding, in people who have stents in the heart. 2 antiplatelet drugs are often used together (dual antiplatelet therapy) to prevent blood clots. It hasn’t been clear whether dual antiplatelet therapy should be used for a shorter or longer time after people get stents.
How the review was done
The researchers did a systematic review, searching for studies published up to November 2014.
They found 10 randomized controlled trials, with 31,666 people (average age 62 to 68 years). In these trials, 63% to 81% of the people were men.
The key features of the trials were:
- people had drug-eluting stents placed in heart arteries;
- dual antiplatelet therapy was taken for a shorter time (3 months, 6 months, or 12 months) or a longer time (12 months or more) after stents were placed; and
- dual antiplatelet therapy most often included aspirin combined with clopidogrel.
What the researchers found
Compared with dual antiplatelet therapy taken for 1 year or more, shorter use reduced deaths and bleeding but increased heart attacks and blood clots from the stent.
Conclusion
After drug-coated stents are placed in heart arteries, use of dual antiplatelet therapy for about 1 year or less reduces deaths and bleeding but increases heart attacks and blood clots in stents compared with longer use.
Shorter vs longer use of dual antiplatelet therapy after drug-coated stents were placed in heart arteries
| Outcomes | Number of trials and people | Rate of events with shorter therapy | Rate of events with longer therapy | Absolute effect of shorter therapy |
| Death for any reason | 10 trials (31,666 people) | 1.5% | 1.8% | About 3 fewer people out of 1000 died (from fewer than 1 to as many as 6 out of 1000) |
| Any bleeding | 9 trials (26,621 people) | 1.7% | 3.0% | About 13 fewer people out of 1000 had any bleeding (from as few as 10 to as many as 15 out of 1000) |
| Major bleeding | 10 trials (31,666 people) | 0.8% | 1.4% | About 6 fewer people out of 1000 had major bleeding (from as few as 4 to as many as 7 out of 1000) |
| Heart attack | 10 trials (31,666 people) | 2.0% | 1.5% | About 5 more people out of 1000 had a heart attack (from as few as 1 to as many as 10 out of 1000) |
| Stroke | 10 trials (31,666 people) | 0.67% | 0.65% | No difference in effect* |
| Blood clots from the stent | 9 trials (26,621 people) | 0.7% | 0.4% | About 3 more people out of 1000 had a blood clot (from fewer than 1 to as many as 7 out of 1000) |
Related Topics
Glossary
Also known as coronary artery disease (CAD), is a narrowing of the blood vessels (coronary arteries) that supply oxygen and blood to the heart.
Studies where people are assigned to one of the treatments purely by chance.
Small mesh tubes.
A comprehensive evaluation of the available research evidence on a particular topic.
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