# Bloedingsgerelateerde sterfte naar DAPT-duur na coronaire stenting

*geplaatst 2017-04-25 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2017.02.029 · https://hartvaat.nl/2017/04/25/bloedingsgerelateerde-sterfte-naar-dapt-duur-na-coronaire-stenting/*

Analyse van bloedingsgerelateerde sterfte in relatie tot de duur van duale antiplaatjestherapie na stenting. Kwantificeert het mortaliteitsrisico van de bloedingscomplicaties.

## English: Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet Therapy After Coronary Stenting.

This analysis quantified the risk of bleeding-related death associated with extended DAPT after coronary stenting, providing the mortality data needed to balance the ischemic protection against bleeding harm of prolonged antiplatelet therapy.

## Abstract (original, from the publication)

BACKGROUND: Although some randomized controlled trials (RCTs) and meta-analyses have suggested that prolonged dual-antiplatelet therapy (DAPT) may be associated with increased mortality, the mechanistic underpinnings of this association remain unclear. OBJECTIVES: The aim of this study was to analyze the associations among bleeding, mortality, and DAPT duration after drug-eluting stent implantation in a meta-analysis of RCTs. METHODS: RCTs comparing different DAPT durations after drug-eluting stent placement were sought through the MEDLINE, Embase, and Cochrane databases and the proceedings of international meetings. Deaths were considered possibly bleeding related if occurring within 1 year of the episodes of bleeding. Primary analysis was by intention-to-treat. Secondary analysis was performed in a modified intention-to-treat population in which events occurring when all patients were on DAPT were excluded. RESULTS: Individual patient data were obtained for 6 RCTs, and aggregate data were available for 12 RCTs. Patients with bleeding had significantly higher rates of mortality compared with those without, and in a time-adjusted multivariate analysis, bleeding was an independent predictor of mortality occurring within 1 year of the bleeding episode (hazard ratio: 6.93; 95% confidence interval: 4.53 to 10.60; p < 0.0001). Shorter DAPT was associated with lower rates of all-cause death compared with longer DAPT (hazard ratio: 0.85; 95% confidence interval: 0.73 to 1.00; p = 0.05), which was driven by lower rates of bleeding-related deaths with shorter DAPT compared with prolonged DAPT (hazard ratio: 0.65; 95% confidence interval: 0.43 to 0.99; p = 0.04). Mortality unrelated to bleeding was comparable between the 2 groups. Similar results were apparent in the modified intention-to-treat population. CONCLUSIONS: Bleeding was strongly associated with the occurrence of mortality within 1 year after the bleeding event. Shorter compared with longer DAPT was associated with lower risk for bleeding-related death, a finding that may underlie the lower all-cause mortality with shorter DAPT in the RCTs of different DAPT durations after DES.

Auteurs: Tullio Palmerini, Letizia Bacchi Reggiani, Diego Della Riva, Mattia Romanello, Fausto Feres, Alexandre Abizaid, Martine Gilard, Marie-Claude Morice, Marco Valgimigli, Myeong-Ki Hong, Byeong-Keuk Kim, Yangsoo Jang, Hyo-Soo Kim, Kyung Woo Park, Antonio Colombo, Alaide Chieffo, Jung-Min Ahn, Seung-Jung Park, Stefanie Schüpke, Adnan Kastrati, Gilles Montalescot, Philippe Gabriel Steg, Abdourahmane Diallo, Eric Vicaut, Gerard Helft, Giuseppe Biondi-Zoccai, Bo Xu, Yaling Han, Philippe Genereux, Deepak L Bhatt, Gregg W Stone

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2017.02.029. Bijgewerkt 2026-07-03T13:25:58Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.