{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:46:25Z","timestamp":1761561985423},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,9,11]],"date-time":"2015-09-11T00:00:00Z","timestamp":1441929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovascular Therapeutics"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The optimal duration of dual antiplatelet therapy (<jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content>) after drug\u2010eluting stent implantation (<jats:styled-content style=\"fixed-case\">DES<\/jats:styled-content>) is not certain. The <jats:styled-content style=\"fixed-case\">AHA<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">ACC<\/jats:styled-content> guidelines recommend 12\u00a0months of <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> based on observational trials. Recently, several large randomized controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>) suggested a noninferiority of shorter duration of <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> and other trials showed a benefit from extended duration of <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> after 12\u00a0months of <jats:styled-content style=\"fixed-case\">DES<\/jats:styled-content> implantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed databases were searched for <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s comparing the continued use of <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> to shorter duration of <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> (aspirin alone) for variable durations beyond 3\u00a0months of <jats:styled-content style=\"fixed-case\">DES<\/jats:styled-content> implantation. Our analysis was limited to trials with clinical outcomes. Odds ratio (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>) and 95% confidence intervals (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) were calculated using fixed and random\u2010effects models. Subgroup analyses were performed for second generation <jats:styled-content style=\"fixed-case\">DES<\/jats:styled-content> and for trials comparing 12\u00a0months of <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> vs. earlier interruption or longer duration of <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 10 <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s including 32,136 subjects randomized to continued use of <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> vs. aspirin alone for variable durations after 3\u00a0months of <jats:styled-content style=\"fixed-case\">DES<\/jats:styled-content> implantation. There was no significant heterogeneity among studies (Q test <jats:italic>P<\/jats:italic>\u00a0&gt;\u00a00.1). Compared to shorter <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content>, longer <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> resulted in a significant reduction in stent thrombosis (0.3% vs. 0.7%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) and myocardial infarction (1.3% vs. 2%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01), and a significant increase in major bleeding (0.8% vs. 0.4%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). There was no difference in cardiac deaths or stroke. All\u2010cause deaths were slightly lower with shorter <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> compared to longer <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.8, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.7 to 0.99, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04). A small number of subjects were included between 3 and 6\u00a0months after <jats:styled-content style=\"fixed-case\">DES<\/jats:styled-content> implantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> continued beyond 6\u00a0months after second generation <jats:styled-content style=\"fixed-case\">DES<\/jats:styled-content> implantation decreases stent thrombosis and myocardial infarction, but increases major bleeding and all\u2010causes mortality compared to shorter <jats:styled-content style=\"fixed-case\">DAPT<\/jats:styled-content> (aspirin alone). 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