Long-Term Dual Antiplatelet Therapy Increases Risk for Bleeding in Patients With Diabetes

In patients with diabetes who have had a drug-eluting stent implanted, long-term dual antiplatelet therapy (DAPT) confers no apparent cardiovascular benefits and is associated with higher bleeding risk than short-term therapy, according to a new meta-analysis.

DAPT is intended to reduce the risk of stent thrombosis and coronary atherothrombotic events after a stent implantation. However, the optimal duration of therapy is controversial.

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o assess the clinical outcomes of short- vs long-term DAPT, the researchers searched online databases for randomized controlled trials comparing durations of DAPT after a drug-eluting stent was placed.

Overall, 6 trials were included in the analysis. Of the 11,473 patients analyzed, 3681 had diabetes, 7708 did not, and 84 had missing information.

The results showed that diabetes was an independent predictor of major adverse cardiac events. However, patients with diabetes who were on long-term DAPT had a lower risk of definite or probable stent thrombosis than those on short-term DAPT, although results suggest patients in both groups may see benefits.

Compared with short-term DAPT, long-term DAPT did not decrease the risk of cardiac events but increased the risk of major or minor bleeding events in patients regardless of diabetes status.

“Although the presence of diabetes emerged as an independent predictor of [major adverse cardiac events] after implantation of a drug eluting stent, compared with short term DAPT, long term DAPT did not reduce the risk of MACE but increased the risk of bleeding among patients with stents with and without diabetes,” the researchers concluded.

—Amanda Balbi

Reference:

Gargiulo G, Windecker S, da Costa BR, et al. Short term versus long term dual antiplatelet therapy after implantation of drug eluting stent in patients with or without diabetes: systematic review and meta-analysis of individual participant data from randomised trials [published online November 3, 2016]. BMJ. http://dx.doi.org/10.1136/bmj.i5483.