Shorter- versus Longer-duration Dual Antiplatelet Therapy in Patients with Diabetes Mellitus Undergoing Drug-eluting Stents Implantation: A Meta-analysis of Randomized Controlled Trials.

He Huang; Ya LI; Yu Chen; Guo-sheng FU

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Shorter- versus Longer-duration Dual Antiplatelet Therapy in Patients with Diabetes Mellitus Undergoing Drug-eluting Stents Implantation: A Meta-analysis of Randomized Controlled Trials.

Author: He HUANG ¹ ; Ya LI ² ; Yu CHEN ² ; Guo-Sheng FU ¹
Author Information

1. Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.
2. Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.
Publication Type:Journal Article
MeSH: Diabetes Mellitus; therapy; Drug-Eluting Stents; adverse effects; Humans; Platelet Aggregation Inhibitors; therapeutic use; Randomized Controlled Trials as Topic; Thrombosis; prevention & control
From: Chinese Medical Journal 2016;129(23):2861-2867
CountryChina
Language:English
Abstract:
BACKGROUNDPatients with diabetes mellitus (DM) have a higher risk of thromboembolic events; however, the optimal duration of dual antiplatelet therapy (DAPT) remains unclear. The goal of this study was to assess the efficacy and safety of various DAPT durations in patients with DM undergoing drug-eluting stent implantation.
METHODSWe conducted a literature search for randomized controlled trials (RCTs). We searched databases including EMBASE, PubMed, Cochrane Library, and Scopus up to June 2016. Investigators extracted data independently, including outcomes, characteristics, and study quality. A random-effect model was used to pool odds ratios (OR s) with 95% confidence intervals (CI s) of the clinical outcomes.
RESULTSSix RCTs totaling 6040 patients with DM were included in the study. Shorter-duration DAPT resulted in an increased rate of stent thrombosis (ST) (OR, 1.83, 95% CI: 1.03-3.26, P = 0.04), but did not increase the risk of myocardial infarction (OR, 1.33, 95% CI: 0.71-2.47, P = 0.37), stroke (OR, 0.96, 95% CI: 0.52-1.77, P = 0.90), target vessel revascularization (OR, 1.19, 95% CI: 0.46-3.07, P = 0.71), all-cause death (OR: 0.72, 95% CI: 0.48-1.09, P = 0.12), or cardiac death (OR, 0.82, 95% CI: 0.49-1.36, P = 0.44) significantly. Shorter-duration DAPT was associated with a decreased risk of major bleeding (OR, 0.60, 95% CI: 0.38-0.94, P = 0.02).
CONCLUSIONIn patients with DM, longer-duration DAPT had a lower risk of ST, but was associated with an increased bleeding risk.