Objective To assess the efficiency and safety of the use of different dual antiplatelet therapy in patients undergoing percutaneous coronary intervention.
Methods Cochrane Library, MEDLINE, EMBASE, CBM, CNKI, and VIP, were searched up to October 2011. Randomized controlled trials comparing the efficiency and safety with short duration of treatment (≤6months) versus long duration of treatment ( > 6months) of dual antiplatelet therapy on percutaneous coronary intervention which have been reported were enrolled. No language restriction was enforced. The quality of the included studies was critically evaluated. Data analyses were performed using the Cochrane Collaboration’s RevMan 5.1 software.
Results Eight trials were included. Three randomised controlled trials and five observational study trials met the inclusion criteria and were incorporated into the primary analysis. Meta-analysis showed that the incidence of death or myocardial infarction in long duration treatment group was lower than short duration treatment group in randomised controlled trials [OR = 0.74, 95% confidence interval [CI] 0.56 to 0.98, P < 0.0001]. Meanwhile, Combined observational studies showed that incidence of death or myocardial infarction in long duration treatment group was lower than short treatment group [OR = 0. 7, 95% confidence interval [CI]0. 45 to 1. 08, P = 0. 11]. We also explored the heterogeneity between the randomised controlled studies and observational studies. In randomised controlled trials, the incidence of major bleeding events of short treatment group was lower than long treatment group [OR = 1.29, 95% confidence interval [CI] 0.99 to 1.69, P = 0.06]. Meta-analysis of observational studies showed that the incidence of late stent thrombosis in long treatment group was lower than short treatment group [OR = 0.40, 95% confidence interval [CI] 0.15 to 1.07, P = 0.07].
Conclusions The long duration of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention can reduce the incidence of death or myocardial infarction. There is a trend of decreasing the rate of late stent thrombosis in long treatment group. The incidence of bleeding does not increase obviously in the long treatment group.
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