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  • Clinical benefits of prolonged dual antiplatelet therapy following complex percutaneous coronary intervention

    Author(s)
    Subhaharan, Deloshaan
    Mridha, Naim
    Singh, Kuljit
    Griffith University Author(s)
    Singh, Kuljit
    Subhaharan, Deloshaan
    Mridha, Naim
    Year published
    2019
    Metadata
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    Abstract
    AIMS: Prolonged dual antiplatelet therapy (DAPT) requires consideration of both reduced thrombotic events and increased bleeding risk. The associated subtle balance between the benefits and harms depends upon patient's clinical factors and complexity of the coronary anatomy. Our aim was to assess the safety and efficacy of prolonged (>12 months) DAPT in patients undergoing complex percutaneous coronary intervention (PCI). METHODS AND RESULTS: A thorough computer-based search was performed using four major databases. Complex PCI was defined as a procedure with at least one of the following angiographic characteristics: 3 ...
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    AIMS: Prolonged dual antiplatelet therapy (DAPT) requires consideration of both reduced thrombotic events and increased bleeding risk. The associated subtle balance between the benefits and harms depends upon patient's clinical factors and complexity of the coronary anatomy. Our aim was to assess the safety and efficacy of prolonged (>12 months) DAPT in patients undergoing complex percutaneous coronary intervention (PCI). METHODS AND RESULTS: A thorough computer-based search was performed using four major databases. Complex PCI was defined as a procedure with at least one of the following angiographic characteristics: 3 vessels treated, >3 stents implanted, >3 lesions treated, bifurcation lesions, total stent length >60 mm, left main or proximal left anterior descending, a vein graft stent, or chronic total occlusion as target lesion. Of the 3543 titles searched, 5 studies met the inclusion criteria comparing short and prolonged DAPT therapy. We applied a random-effects model to acknowledge the variation in study design, treatment duration, and length of follow-up among studies. There was a reduction in cardiac mortality [odds ratio (OR) 0.57, 95% confidence interval (CI): 0.35-0.92; P = 0.02, I = 0%] and major adverse cardiovascular events (OR 0.76, 95% CI: 0.59-0.96; P = 0.02, I = 22%) with prolonged DAPT. Major bleeding was increased with prolonged DAPT (OR 1.75, 95% CI: 1.20-2.20; P = 0.004, I = 0%). There was no difference in the all-cause mortality (OR 0.86, 95% CI: 0.61-1.22; P = 0.41, I = 0%). CONCLUSION: Prolonged DAPT reduces cardiac mortality and major adverse cardiovascular events in complex PCI. The results would need confirmation in a larger randomized study.
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    Journal Title
    Coronary Artery Disease
    DOI
    https://doi.org/10.1097/MCA.0000000000000827
    Subject
    Cardiovascular medicine and haematology
    Clinical sciences
    Publication URI
    http://hdl.handle.net/10072/389038
    Collection
    • Journal articles

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