Evidence map›Paper›PMID 25467565›Full record

SynthesisLancet (London, England)2015

Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis.

Sammy Elmariah, Laura Mauri, Gheorghe Doros, Benjamin Z Galper, Kelly E O'Neill, Philippe Gabriel Steg, Dean J Kereiakes, Robert W Yeh

Erratum issuedAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Lancet (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 48 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
48citing papers in PubMed, 12 pooled it
23.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

48 citing papers in PubMed, 12 syntheses or guidelines pooled it, 169 citations in OpenAlex.

  1. Bayesian Methods for Meta-Analyses of Binary Outcomes: Implementations, Examples, and Impact of Priors.International journal of environmental research and public health · 2021
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  8. Prolonged dual antiplatelet therapy after drug-eluting stenting: meta-analysis of randomized trials.Clinical research in cardiology : official journal of the German Cardiac Society · 2015
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  12. Potent P2Y12 Inhibitor Monotherapy Versus Dual Antiplatelet Therapy After Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 3 countries.

Sammy ElmariahCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA.
Laura MauriDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA.
Gheorghe DorosHarvard Clinical Research Institute, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
Benjamin Z GalperDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Kelly E O'NeillDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Philippe Gabriel StegUniversité Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodeling), INSERM U-1148 and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK.
Dean J KereiakesThe Lindner Research Center, The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA.
Robert W YehCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA. Electronic address: ryeh@mgh.harvard.edu.
Harvard University · USBaim Institute for Clinical Research · USBrigham and Women's Hospital · USChrist Hospital · USMassachusetts General Hospital · USSorbonne Paris Cité · FR

Funding

Balancing the Risks of Ischemia and Bleeding in Percutaneous Coronary InterventioK23HL118138 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI YEH, ROBERT · 2013 to 2017
$740k
NHLBI NIH HHS K23 HL118138
6 · The paper itself

Abstract

backgroundTreatment with aspirin and a P2Y12 inhibitor is commonly used in patients with cardiovascular disorders. The overall effect of such treatment on all-cause mortality is unknown. In the Dual Antiplatelet Therapy (DAPT) Study, continuation of dual antiplatelet therapy beyond 12 months after coronary stenting was associated with an unexpected increase in non-cardiovascular death. In view of the potential public health importance of these findings, we aimed to assess the effect of extended duration dual antiplatelet therapy on mortality by doing a meta-analysis of all randomised, controlled trials of treatment duration in various cardiovascular disorders.

methodsWe searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomised controlled trials assessing the effect of extended duration versus no or short duration dual antiplatelet therapy, published before Oct 1, 2014. We did a meta-analysis to pool results with a hierarchical Bayesian random-effects model. The primary outcomes were hazard ratios comparing rates of all-cause, cardiovascular, and non-cardiovascular death.

findingsIncluding the DAPT Study, we identified 14 eligible trials that randomly assigned 69,644 participants to different durations of dual antiplatelet therapy. Compared with aspirin alone or short duration dual antiplatelet therapy (≤6 months), continued treatment was not associated with a difference in all-cause mortality (hazard ratio [HR] 1·05, 95% credible interval [CrI] 0·96-1·19; p=0·33). Similarly, cardiovascular (1·01, 0·93-1·12; p=0·81) and non-cardiovascular mortality (1·04, 0·90-1·26; p=0·66) were no different with extended duration versus short duration dual antiplatelet therapy or aspirin alone.

interpretationExtended duration dual antiplatelet therapy was not associated with a difference in the risk of all-cause, cardiovascular, or non-cardiovascular death compared with aspirin alone or short duration dual antiplatelet therapy.

fundingNone.

Indexed as

Cardiovascular DiseasesDrug Therapy, CombinationEpidemiologic MethodsHumansLong-Term CarePlatelet Aggregation InhibitorsPurinergic P2Y Receptor AntagonistsRandomized Controlled Trials as TopicTreatment OutcomePlatelet Aggregation InhibitorsPurinergic P2Y Receptor Antagonists

Identifiers

PMID25467565
PMCPMC4386690
OpenAlexW2136520492

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.