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Efficacy and safety of short-term 1-3 months versus standard 12 months dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized clinical trials

机译：短期1-3个月的疗效和安全性与标准12个月双抗血小板治疗进行经皮冠状动脉介入的患者：随机临床试验的荟萃分析

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Dual antiplatelet therapy (DAPT) is the basis of preventing stent thrombosis and ischemic events after percutaneous coronary intervention (PCI), but prolonging the duration of DAPT will increase the risk of bleeding. The optimal duration of DAPT after PCI remains controversial at present. The purpose of this meta-analysis was to investigate the efficacy and safety of short-term DAPT in patients undergoing PCI. PubMed, Embase, Cochrane and Web of science from inception to September 2019 were systematically searched. Randomized controlled trials were included to compare short term (3 months or less) with a standard 12-months DAPT in patients undergoing PCI. Random effect model and fixed effect model wereused to calculate the risk ratio (RR) and 95% confidence interval (CI) of each endpoint. This meta-analysis included 38479 patients undergoing PCI from 8 randomized clinical trials. No difference was observed in the risk of all-cause death (RR 0.92, 95% CI 0.80-1.06,P= 0.25), cardiovascular death (RR 0.88, 0.69-1.12,P= 0.29), myocardial infarction (RR 1.05, 0.94-1.19,P= 0.38), definite or probable stent thrombosis (RR 1.05, 0.80-1.36,P= 0.73), and stroke (RR 1.02, 0.80-1.30,P= 0.89) between short term and standard DAPT. The short-term DAPT could reduce the risk of major bleeding (RR 0.67, 0.48-0.94,P= 0.02) and any bleeding (RR 0.63, 0.48-0.82, P = 0.0005) compared with 12 months of DAPT. In conclusion, the short-term DAPT can reduce the risk of bleeding compared with standard DAPT, without increasing the risk of death or ischemia (Registered by PROSPERO, CRD42020153881).
机译：双重抗血小板治疗（DAPT）是预防经皮冠状动脉介入术（PCI）后支架血栓形成和缺血性事件的基础，但延长DAPT的持续时间会增加出血风险。PCI术后DAPT的最佳持续时间目前仍有争议。这项荟萃分析的目的是调查接受PCI的患者短期DAPT的有效性和安全性。从开始到2019年9月，对PubMed、Embase、Cochrane和科学网进行了系统搜索。纳入随机对照试验，比较接受PCI患者的短期（3个月或更短）和标准12个月DAPT。采用随机效应模型和固定效应模型计算各终点的风险比（RR）和95%置信区间（CI）。这项荟萃分析包括8项随机临床试验中38479名接受PCI的患者。短期DAPT与标准DAPT在全因死亡（RR 0.92，95%CI 0.80-1.06，P=0.25）、心血管死亡（RR 0.88，0.69-1.12，P=0.29）、心肌梗死（RR 1.05，0.94-1.19，P=0.38）、明确或可能的支架血栓形成（RR 1.05，0.80-1.36，P=0.73）和中风（RR 1.02，0.80-1.30，P=0.89）的风险方面没有观察到差异。与12个月的DAPT相比，短期DAPT可降低大出血风险（RR 0.67,0.48-0.94，P=0.02）和任何出血风险（RR 0.63,0.48-0.82，P=0.0005）。总之，与标准DAPT相比，短期DAPT可以降低出血风险，而不会增加死亡或缺血的风险（由PROSPERO注册，CRD4200153881）。

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