Duration of Dual Antiplatelet Therapy After Stent Implantation, Still an Enigma: A Systematic Review of Randomized Clinical Trials

Dual antiplatelet therapy (DAPT) is used in patients after drug-eluting stent (DES) implantation to prevent stent thrombosis and ischemic events. The ideal duration of DAPT in patients after DES implantation is a topic of debate among clinicians. In the past, many research studies were published related to an optimal duration of DAPT after DES implantation. In common practice, DAPT should be continued for one year or more after percutaneous coronary intervention (PCI) followed by DES implantation. The duration of DAPT is significant as long-term DAPT has beneficial effects but is associated with side effects like bleeding. On the other hand, short-term DAPT has a lower risk of bleeding, but it increases the rate of stent thrombosis or ischemic events. Our aim in this systematic review is to solve the dispute regarding the duration of DAPT after DES implantation. So, we tried to find the efficacy and safety of short-term (six months) DAPT by compiling data from randomized control trials (RCTs). We conducted this systematic review following the guidelines defined in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. We searched for our data from multiple databases like PubMed, Web of Science, ScienceDirect, and Google Scholar. We reviewed 10964 studies and then applied inclusion/exclusion criteria and PRISMA guidelines. Finally, we were left with only 21 studies regarding the optimal duration of DAPT after DES implantation. Our systematic review will help determine the non-inferiority of short-term (six months) DAPT to long-term (12 months) DAPT. Furthermore, we also noticed with short-term (six months) DAPT, there was decreased incidence of bleeding as compared to DAPT for long-term. But more studies were required to establish the safety and effectiveness of short-term (six months) DAPT compared to long-term (12 months) DAPT in patients after DES implantation.