Lack of Evidence for Dual Antiplatelet Therapy after Endovascular Arterial Procedures: A Meta-analysis
Open accessAbstract
Introduction Dual antiplatelet therapy (DAPT) has mainly replaced mono antiplatelet therapy (MAPT) and is recommended after arterial endovascular revascularization. The aim of this meta-analysis was to summarize the available evidence for DAPT after endovascular revascularization throughout the arterial system.Methods A systematic search was performed in Medline, Embase, and the Cochrane Register. Two reviewers independently performed data extraction and quality assessment using the Cochrane Collaboration risk of bias assessment tool. Included in the search were randomized controlled trials (RCTs) comparing DAPT with MAPT after endovascular procedures for the treatment of coronary, carotid, or peripheral artery disease, reporting at least one clinical outcome. Articles were excluded if patients received anticoagulation in addition to antiplatelet therapy in the post-procedural phase. The primary outcome was restenosis or stent thrombosis, and secondary outcomes were major adverse cardiac events (MACE), target lesion revascularization, cerebrovascular accident or transient ischemic attack, bleeding, and death. Meta-analyses of binary outcomes were performed using the random effects model and described as risk ratios (RRs) and 95% confidence intervals (95% CIs). Chi-square tests were used to test for heterogeneity.Results Nine articles were included in this study, involving lower limb peripheral arteries (1), carotid arteries (2), and coronary arteries (6). The pooled results of coronary trials showed a RR for restenosis with DAPT of 0.60 (95% CI 0.28-1.31) and for myocardial infarction 0.49 (95% CI 0.12-2.03). In the carotid artery trials the RR for restenosis was 0.22 (95% CI 0.04-1.20) and for peripheral arteries 1.02 (95% CI 0.56-1.82). A meta-analysis of bleeding risk of all the included trials showed a RR of 1.06 (95% CI 0.32-3.52) with DAPT.Conclusion The available evidence comparing DAPT with MAPT after endovascular arterial revascularization is limited and the majority of trials were conducted in the cardiology field. No significant evidence for superiority of DAPT compared with MAPT was found, but there was also no evidence of an increased bleeding risk with DAPT over MAPT.
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Meta-analysis found no significant advantage of dual versus mono antiplatelet therapy after endovascular arterial revascularization in restenosis or stent thrombosis, but increased bleeding risk with dual antiplatelet therapy.
“A meta-analysis comparing dual antiplatelet versus mono antiplatelet therapy after endovascular arterial revascularization found no significant advantage in restenosis or stent thrombosis but showed an increased risk of bleeding with dual antiplatelet therapy [81].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [81]
The Discussion (p. 6) reports no significant reduction in restenosis or stent thrombosis with dual therapy, supporting that part of the claim. But it explicitly says the pooled risk of bleeding was not significantly different; the bleeding analysis (p. 6) reports confidence intervals that include no difference. The claim overstates the bleeding finding as an increased risk. (LLM, conf=0.93)
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- Authors
- Peeters Weem, S. M. O., van Haelst, S. T. W., den Ruijter, H. M., Moll, F. L., & de Borst, G. J.
- Affiliations
- University Medical Center Utrecht (NL)
- ORCID
- Moll, F.L.
- Venue
- European Journal of Vascular and Endovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2016-08
- Volume
- 52
- Issue
- 2
- Pages
- 253-262
- ISSN
- 1078-5884 (ISSN-L)
- OpenAlex
- W2404820780
- Cited by
- 40
- References
- 53
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 4 · 2022: 5 · 2021: 4 · 2020: 4 · 2019: 2 · 2018: 7 · 2017: 5 · 2016: 2
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- European Journal of Vascular and Endovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Keywords
- dual antiplatelet therapy, endovascular revascularization, coronary artery disease, carotid artery disease, peripheral arterial disease, restenosis, stent thrombosis, major adverse cardiac events, bleeding risk, target lesion revascularization, cerebrovascular events, myocardial infarction, risk of bias
- MeSH terms
- Arterial Occlusive Diseases, Carotid Artery Diseases, Coronary Disease, Drug Therapy, Combination, Humans, Platelet Aggregation Inhibitors, Postoperative Care, Treatment Outcome, Endovascular Procedures, Peripheral Arterial Disease
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