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Generation Bias in Meta-Analysis of Duration of Dual Antiplatelet Therapy Following Drug-Eluting Stent

      In a recent meta-analysis published in the Journal, El-Hayek et al
      • El-Hayek G.
      • Messerli F.
      • Bangalore S.
      • Hong M.K.
      • Herzog E.
      • Benjo A.
      • Tamis-Holland J.E.
      Meta-analysis of randomized clinical trials comparing short-term versus long-term dual antiplatelet therapy following drug-eluting stents.
      analyzed the use of short-term (3 to 6 months) dual antiplatelet therapy (DAPT) with long-term (12 to 24 months) DAPT after drug-eluting stent (DES) placement. The investigators were measured in their conclusions regarding stent thrombosis (ST) in their landmark analysis stating, “Although there was no significant difference in ST using this analysis, there was a near twofold greater rate of ST in the group of patients assigned to a short course of DAPT. These findings raise concerns regarding the safety of shorter DAPT and certainly merit further evaluation with a larger data set of patients, especially to identify those who may be at high risk for ST from the short DAPT.”
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      References

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        • Messerli F.
        • Bangalore S.
        • Hong M.K.
        • Herzog E.
        • Benjo A.
        • Tamis-Holland J.E.
        Meta-analysis of randomized clinical trials comparing short-term versus long-term dual antiplatelet therapy following drug-eluting stents.
        Am J Cardiol. 2014; 114: 236-242
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        A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation).
        J Am Coll Cardiol. 2012; 60: 1340-1348
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        Should duration of dual antiplatelet therapy depend on the type and/or potency of implanted stent? A pre-specified analysis from the PROlonging Dual antiplatelet treatment after Grading stent-induced Intimal hyperplasia studY (PRODIGY).
        Eur Heart J. 2013; 34: 909-919

      Linked Article

      • Meta-Analysis of Randomized Clinical Trials Comparing Short-Term Versus Long-Term Dual Antiplatelet Therapy Following Drug-Eluting Stents
        American Journal of CardiologyVol. 114Issue 2
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          Current guidelines recommend 12 months of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation in the absence of increased bleeding risk. Studies have suggested that early discontinuation of DAPT can result in an increased risk of stent thrombosis. However, given the potential for major bleeding, the optimal duration of DAPT after DES implantation remains uncertain. We searched PubMed, EMBASE, Scopus, and ClinicalTrials.gov databases from inception until October 2013 for randomized controlled trials that compared shorter versus longer DAPT duration after DES implantation.
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