Abstract 19004: The Impact of Dual Antiplatelet Therapy on Mortality: A Patient-Level Meta-Analysis
Background: Continuation of clopidogrel therapy beyond 12 months after percutaneous coronary intervention reduces the risk of stent thrombosis and major adverse cardiovascular (CV) and cerebrovascular events, yet was associated with increased non-cardiovascular mortality within the Dual Antiplatelet Therapy (DAPT) Study. Cancer-related, and not bleeding-related mortality accounted for the excess risk associated with continued clopidogrel use. We sought to determine the impact of continued clopidogrel use on mortality and to evaluate bleeding- and cancer-related mortality within a patient-level meta-analysis of randomized clinical trials.
Methods: Meta-analytic clinical event rates for all-cause, CV, non-CV, cancer-related, and bleeding-related mortality, myocardial infarction (MI), stroke, fatal and major non-fatal bleeding were generated using patient-level data from 6 randomized trials comparing prolonged clopidogrel therapy to no or short-duration clopidogrel therapy on a background of aspirin.
Results: Among 48,817 patients followed for a median of 546 days after randomization, dual-antiplatelet therapy (N=24411) or placebo (N=24406) resulted in comparable all-cause, CV, non-CV, cancer-related mortality (Table). While infrequent, fatal bleeding was more common with continued clopidogrel use, as was major non-fatal bleeding. Rates of ischemic events, including MI and stroke, were significantly lower in patients receiving continued clopidogrel therapy.
Conclusions: Extended duration dual antiplatelet therapy with clopidogrel and aspirin does not impact mortality but does reduce rates of MI and stroke and increase rates of fatal and major non-fatal bleeding. These findings highlight the need for careful patient selection for extended duration treatment.
Author Disclosures: S. Elmariah: None. G. Doros: Employment; Significant; Harvard Clinical Research Institute. O. Benavente: Research Grant; Significant; National Institutes of Health. D.L. Bhatt: Research Grant; Significant; Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company. S. Connolly: Honoraria; Significant; Sanofi Aventis, Bristol Myers Squibb/Pfizer, Boehringer-Ingelheim, Portola, Bayer, Boston Scientific. Consultant/Advisory Board; Significant; Sanofi Aventis, Bristol Myers Squibb/Pfizer, Boehringer-Ingelheim, Portola, Bayer, Boston Scientific. S. Yusuf: Research Grant; Significant; Sanofi Aventis. Honoraria; Modest; Sanofi Aventis. Other; Modest; Sanofi Aventis. S. Steinhubl: None. Y. Liu: None. R.W. Yeh: Research Grant; Significant; Abiomed, Boston Scientific. Consultant/Advisory Board; Modest; Boston Scientific. Consultant/Advisory Board; Significant; Abbott. L. Mauri: Research Grant; Modest; Boeringher Ingelheim, ReCor. Speakers Bureau; Modest; AstraZeneca, Sanofi, Daiichi Sankyo. Consultant/Advisory Board; Modest; Amgen, St. Jude Medical, Biotronik, Corvia.
- © 2016 by American Heart Association, Inc.