The Optimal Duration Of Dual Antiplatelet Therapy In Patients Undergoing Percutaneous Coronary Intervention: A Meta-analysis

Objective: To assess the efficiency and safety of the use of different dual antiplatelettherapy in patients undergoing percutaneous coronary intervention. Methods: CochraneLibrary, MEDLINE, EMBASE, CBM, CNKI, and VIP, were searched up to October2011.Randomized controlled trials comparing the efficiency and safety with short duration oftreatment(≤6months)versus long duration of treatment(＞6months)of dual antiplatelettherapy on percutaneous coronary intervention which have been repoted were enrolled. Nolanguage restriction was enforced. The quality of the included studies was criticallyevaluated. Data analyses were performed using the Cochrane Collaboration’s RevMan5.1software. Results: Eight trials were included. Three randomized controlled trials and fiveobservational study trials met the inclusion criteria and were incorporated into the primaryanalysis. Meta-analysis showed that the incidence of death or myocardial infarction inlong duration treatment group was lower than short duration treatment group inrandomized controlled trials [OR＝0.74,95%confidence interval[CI]0.56to0.98, P＜0.0001]. Meanwhile, Combined observational studies showed that incidence of death ormyocardial infarction in long duration treatment group was lower than short treatmentgroup [OR＝0.7,95%confidence interval[CI]0.45to1.08, P＝0.11]. We also exploredthe heterogeneity between the randomized controlled studies and observational studies. Inrandomized controlled trials, the incidence of major bleeding events of short treatmentgroup was lower than long treatment group[OR＝1.29,95%confidence interval[CI]0.99to1.69, P＝0.06]. Meta-analysis of observational studies showed that the incidence of latestent thrombosis in long treatment group was lower than short treatment group [OR＝0.40, 95%confidence interval[CI]0.15to1.07, P＝0.07]. Conclusion: The long duration ofdual antiplatelet therapy in patients undergoing percutaneous coronary intervention canreduce the incidence of death or myocardial infarction. There is a trend of decreasing therate of late stent thrombosis in long treatment group. The incidence of bleeding does notincrease obviously in the long treatment group.