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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Optimal Duration of Dual Antiplatelet Therapy After Carotid Artery Stenting: A Nationwide Cohort Study
Joonsang Yoo1, Hyunsun Lim2, Kwon-Duk Seo3,4,5
1Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Korea (J.Y.).
Insights
Short-duration dual antiplatelet therapy (DAPT) is as effective and safe as long-duration DAPT following carotid artery stenting (CAS). This finding supports shorter DAPT durations for patients undergoing CAS, balancing efficacy and safety.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Trials
Background:
- Carotid artery stenting (CAS) offers an alternative to endarterectomy for carotid artery stenosis.
- Dual antiplatelet therapy (DAPT) is crucial post-CAS to prevent ischemic stroke.
- The optimal duration of DAPT after CAS requires further investigation.
Purpose of the Study:
- To compare the clinical outcomes of short-duration versus long-duration DAPT after CAS.
- To identify differences in ischemic stroke, gastrointestinal bleeding, and intracranial hemorrhage based on DAPT duration.
Main Methods:
- Retrospective analysis of a nationwide Korean Health Insurance Review and Assessment Service database (2007-2019).
- Patients undergoing CAS were categorized into short-DAPT (<6 months) and long-DAPT (≥6 months) groups.
- Inverse probability of treatment weighting and competing risk models were used to analyze outcomes.
Main Results:
- A total of 12,034 patients were analyzed; 2,529 in the short-DAPT group and 9,505 in the long-DAPT group.
- The primary composite outcome (ischemic stroke, GI bleeding, intracranial hemorrhage) did not significantly differ between groups (2.5% vs. 2.1%).
- Specific event rates for stroke, GI bleeding, and intracranial hemorrhage showed no significant differences between short- and long-DAPT groups.
Conclusions:
- Short-duration DAPT is a viable option after CAS, demonstrating comparable clinical efficacy and safety to long-duration DAPT.
- Findings suggest that shorter DAPT regimens can be recommended for patients post-CAS.
- The study provides evidence to guide DAPT duration decisions, potentially reducing treatment burden and costs.
Background:
Carotid artery stenting (CAS) is an alternative treatment for patients with carotid artery stenosis who are not eligible for carotid endarterectomy. Dual antiplatelet therapy (DAPT) after CAS aims to prevent ischemic stroke. However, its optimal duration remains unclear. We aimed to determine the optimal duration of DAPT by identifying the differences in clinical events that occur depending on the DAPT maintenance period.
Methods:
Data were obtained from the nationwide database of the Korean Health Insurance Review and Assessment Service between 2007 and 2019. Patients who received CAS, as identified by procedure codes, were divided into 2 groups according to the duration of DAPT (aspirin and clopidogrel): those who maintained DAPT for at least 90 days but for <6 months (short-DAPT group) and those who maintained it for longer (long-DAPT group). The primary outcome was a composite of ischemic stroke, gastrointestinal bleeding, and intracranial hemorrhage within 12 months of switching to single antiplatelet therapy. Statistical analyses used inverse probability of treatment weighting to balance baseline characteristics, with Cox regression and Fine and Gray competing risk models used to assess outcomes.
Results:
Of the 12 034 patients who underwent CAS, 2529 and 9505 were assigned to the short-DAPT and long-DAPT groups, respectively. In the short-DAPT group, ischemic stroke, gastrointestinal bleeding, and intracranial hemorrhage occurred in 41 (1.6%), 22 (0.9%), and 4 (0.2%) patients, respectively. In the long-DAPT group, ischemic stroke, gastrointestinal bleeding, and intracranial hemorrhage occurred in 108 (1.1%), 87 (0.9%), and 4 (0.04%) patients, respectively. The primary outcome did not differ significantly between the groups (2.5% versus 2.1%; adjusted hazard ratio of long-DAPT to short-DAPT, 0.869 [95% CI, 0.652-1.158]; P=0.337).
Conclusions:
Short-duration DAPT can be recommended, as it does not differ from long-duration DAPT in terms of clinical efficacy and adverse events after CAS.
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