Comparison of the Efficacy of Dual Antiplatelet Treatment at Different Treatment Times in Patients with High Bleeding Risk after PCI: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Objective: This study conducted a systematic review and meta-analysis to evaluate the efficacy and complications of dual antiplatelet therapy in patients with high bleeding risk after percutaneous coronary intervention (PCI) at different treatment durations. Methods: Related studies were searched in PubMed, Web of Science, Cochrane Library, Google Scholar, China national knowledge infrastructure (CNKI), Wanfang, Embase, and VIP databases from the establishment of the database to May 2023. Randomized controlled trials (RCTs) of dual antiplatelet treatment (DAPT) time limit for germination of the coronary artery were screened, and results were integrated and analyzed. The study assessed literature quality using the Jadad scale and conducted meta-analyses with RevMan 5.4, applying appropriate models based on heterogeneity and using Egger's test for publication bias. Sensitivity analysis identified factors contributing to heterogeneity. Results: Fifteen studies with 193,086 patients with PCI, comprising 102,661 cases of DAPT short-term treatment groups (<12 months) and 88,988 cases of DAPT long-term treatment groups (≥12 months), were analyzed. Meta-analysis results showed that the total mortality of short-term DAPT PCI was significantly reduced compared with long-term treatment (relative risk (RR) = 0.49, 95% CI: 0.48–0.51). Cardiac mortality showed a significant decrease (RR = 0.50, 95% CI: 0.48–0.52); Myocardial infarction: The risk of myocardial infarction was significantly reduced (RR = 0.68, 95% CI: 0.66–0.70); There was a significant increase in the risk of stroke (RR = 1.45, 95% CI: 1.37–1.53); The incidence of target vessel revascularization (TVR) showed a significant increase (RR = 1.35, 95% CI: 1.08–1.69); The risk of major bleeding was significantly increased (RR = 1.46, 95% CI: 1.40–1.51). Definite stent thrombosis and incidence of minor bleeding did not increase significantly. Conclusion: Short-course dual antiplatelet therapy (DAPT) has been shown to decrease overall mortality, cardiac mortality, and the risk of myocardial infarction in patients following percutaneous coronary intervention (PCI). However, it is associated with an elevated risk of major bleeding, stroke, and target vessel revascularization (TVR), while the risks of definite stent thrombosis and minor bleeding did not increase significantly. Additional high-quality RCTs should be used to verify the conclusions.