Department of Medicine, Cook County Health, Chicago, Illinois.
Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut.
JAMA Netw Open. 2024 Mar 4;7(3):e244000. doi: 10.1001/jamanetworkopen.2024.4000.
The optimal duration of dual antiplatelet therapy (DAPT) for older adults after percutaneous coronary intervention (PCI) is uncertain because they are simultaneously at higher risk for both ischemic and bleeding events.
To investigate the association of abbreviated DAPT with adverse clinical events among older adults after PCI.
The Cochrane Library, Google Scholar, Embase, MEDLINE, PubMed, Scopus, and Web of Science were searched from inception to August 9, 2023.
Randomized clinical trials comparing any 2 of 1, 3, 6, and 12 months of DAPT were included if they reported results for adults aged 65 years or older or 75 years or older.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was used to abstract data and assess data quality. Risk ratios for each duration of DAPT were calculated with alternation of the reference group.
The primary outcome of interest was net adverse clinical events (NACE). Secondary outcomes were major adverse cardiovascular events (MACE) and bleeding.
In 14 randomized clinical trials comprising 19 102 older adults, no differences were observed in the risks of NACE or MACE for 1, 3, 6, and 12 months of DAPT. However, 3 months of DAPT was associated with a lower risk of bleeding compared with 6 months of DAPT (relative risk [RR], 0.50 [95% CI, 0.29-0.84]) and 12 months of DAPT (RR, 0.57 [95% CI, 0.45-0.71]) among older adults. One month of DAPT was also associated with a lower risk of bleeding compared with 6 months of DAPT (RR, 0.68 [95% CI, 0.54-0.86]).
In this systematic review and meta-analysis of different durations of DAPT for older adults after PCI, an abbreviated DAPT duration was associated with a lower risk of bleeding without any concomitant increase in the risk of MACE or NACE despite the concern for higher-risk coronary anatomy and comorbidities among older adults. This study, which represents the first network meta-analysis of this shortened treatment for older adults, suggests that clinicians may consider abbreviating DAPT for older adults.
经皮冠状动脉介入治疗（PCI）后老年患者双联抗血小板治疗（DAPT）的最佳持续时间尚不确定，因为他们同时存在缺血和出血事件的较高风险。
研究缩短 DAPT 持续时间与 PCI 后老年患者不良临床事件的关系。
从建库到 2023 年 8 月 9 日，检索了 Cochrane 图书馆、谷歌学术、Embase、MEDLINE、PubMed、Scopus 和 Web of Science。
纳入了比较任何 1、3、6 和 12 个月 DAPT 的随机临床试验，如果它们报告了 65 岁或以上或 75 岁或以上成年人的结果。
使用系统评价和荟萃分析的首选报告项目（PRISMA）报告准则提取数据并评估数据质量。用交替参考组计算每个 DAPT 持续时间的风险比。
主要关注的结局是净不良临床事件（NACE）。次要结局为主要不良心血管事件（MACE）和出血。
在 14 项纳入的随机临床试验中，共纳入 19102 名老年患者，1、3、6 和 12 个月 DAPT 的 NACE 或 MACE 风险无差异。然而，与 6 个月 DAPT（相对风险[RR]，0.50[95%CI，0.29-0.84]）和 12 个月 DAPT（RR，0.57[95%CI，0.45-0.71]）相比，3 个月 DAPT 与出血风险降低相关。与 6 个月 DAPT 相比，1 个月 DAPT 也与出血风险降低相关（RR，0.68[95%CI，0.54-0.86]）。
在这项针对 PCI 后老年患者不同 DAPT 持续时间的系统评价和荟萃分析中，与 6 个月 DAPT 相比，缩短 DAPT 持续时间与出血风险降低相关，同时不增加 MACE 或 NACE 的风险，尽管老年患者的冠状动脉解剖结构和合并症风险较高。这项研究代表了针对老年患者缩短治疗的首次网络荟萃分析，表明临床医生可能会考虑为老年患者缩短 DAPT。
