Abstract Number: OC 17.3
Meeting: ISTH 2021 Congress
Background: Deciding on the optimal duration of dual antiplatelet therapy (DAPT) after implantation of a drug-eluting stent (DES) is challenging and evaluation of the safety of different DAPT durations is hampered by heterogenous bleeding definitions across studies. Assessment of the case-fatality rate of bleeding events on DAPT may improve balancing risks and benefits of different DAPT durations.
Aims: To determine the case-fatality rate of major bleeding events in DES-treated patients and compare the rate across different bleeding definitions and DAPT durations.
Methods: Medline, Embase, and Cochrane CENTRAL were searched from inception up to May 22, 2020 for randomized controlled trials which reported fatal bleeding among patients with DES-treated coronary artery disease who were randomized to at least 1 month of DAPT. Two reviewers independently performed study screening, data extraction, and risk of bias assessment (RoB 2). The case-fatality rate of major bleeding was defined as the proportion of fatal bleeds relative to the total number of major bleeds as defined per individual study. Summary estimates for case-fatality rates were calculated using the inverse variance method. We performed subgroup analysis by definition of major bleeding and DAPT duration (i.e., standard 12-month vs extended).
Results: Of 2,243 citations identified, 12 studies were included in the analysis. Fatal bleeds were not reported in 14 otherwise eligible studies. Overall, there were 479 major bleeds including 51 fatal events in 27,733 patients who were allocated to standard 12-month or extended DAPT. The case-fatality rate of major bleeds on DAPT was 11.1% (95% confidence interval, 7.0-17.1%, I2=32%). Results according to the definition of major bleeding and DAPT duration are shown in Figures 1 and 2.
Conclusions: Fatal bleeding is underreported in studies evaluating DAPT for DES-treated patients. The case-fatality rate of major bleeds on DAPT is substantial and may differ by DAPT duration, but low event rates preclude definite conclusions.
To cite this abstract in AMA style:Tritschler T, Patel A, Kraaijpoel N, Di Santo P, Hibbert B, Le Gal G, Castellucci L. Case-fatality Rate of Major Bleeding Events among Patients Treated with Dual Antiplatelet Therapy after Percutaneous Coronary Intervention with Drug-eluting Stent: A Systematic Review and Meta-analysis [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/case-fatality-rate-of-major-bleeding-events-among-patients-treated-with-dual-antiplatelet-therapy-after-percutaneous-coronary-intervention-with-drug-eluting-stent-a-systematic-review-and-meta-analysi/. Accessed September 25, 2021.
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