Related Experiment Video

Updated: Jan 28, 2026

Large Animal Model for Evaluating the Efficacy of the Gene Therapy in Ischemic Heart
06:07

Large Animal Model for Evaluating the Efficacy of the Gene Therapy in Ischemic Heart

Published on: September 2, 2021

2.2K

Dual Antiplatelet Therapy Duration Based on Ischemic and Bleeding Risks After Coronary Stenting

Francesco Costa1, David Van Klaveren2, Fausto Feres3

  • 1Department of Clinical and Experimental Medicine, Policlinic "G. Martino," University of Messina, Messina, Italy; Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.

Journal of the American College of Cardiology
|February 21, 2019
PubMed

Insights

For complex PCI patients, long-term dual antiplatelet therapy (DAPT) benefits ischemic events only if high bleeding risk (HBR) is absent. Bleeding risk, not ischemic risk, should guide DAPT duration decisions in HBR patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Complex percutaneous coronary intervention (PCI) increases ischemic risk, often managed with dual antiplatelet therapy (DAPT).
  • High bleeding risk (HBR) complicates DAPT duration decisions after PCI.
  • Balancing ischemic and bleeding risks is crucial for optimal patient outcomes.

Purpose of the Study:

  • To evaluate the impact of DAPT duration on clinical outcomes in patients undergoing complex PCI.
  • To assess how ischemic and bleeding risks influence the effectiveness of DAPT strategies.
  • To determine whether PCI complexity or bleeding risk should guide DAPT duration.

Main Methods:

  • Analysis of 14,963 patients from 8 randomized trials, with a focus on 3,118 undergoing complex PCI.
  • Stratification of patients based on PCI complexity (≥3 stents, ≥3 lesions, etc.) and bleeding risk (PRECISE-DAPT score ≥25).
  • Randomized allocation to different DAPT durations and evaluation of ischemic and bleeding events.

Main Results:

  • Complex PCI was associated with higher ischemic event rates but not bleeding events.
  • Long-term DAPT reduced ischemic events in non-HBR patients with both complex and non-complex PCI.
  • Long-term DAPT did not benefit HBR patients, and increased bleeding risk in this group, irrespective of PCI complexity.

Conclusions:

  • Patients with complex PCI benefit from long-term DAPT only if they do not have high bleeding risk.
  • Bleeding risk assessment is paramount in guiding DAPT duration decisions, particularly in HBR patients.
  • Clinical decision-making for DAPT duration should prioritize bleeding risk over ischemic risk when these factors are discordant.
Abstract

Keywords:
PRECISE-DAPT scorebleedingcomplex PCIcoronary stentingdual antiplatelet therapy

More Related Videos

Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access05:04

Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access

Published on: November 19, 2020

4.8K
Novel Percutaneous Approach for Deployment of 3D Printed Coronary Stenosis Implants in Swine Models of Ischemic Heart Disease06:39

Novel Percutaneous Approach for Deployment of 3D Printed Coronary Stenosis Implants in Swine Models of Ischemic Heart Disease

Published on: February 18, 2020

7.2K

Related Concept Videos

Bleeding in Fresh Concrete01:22

Bleeding in Fresh Concrete

Bleeding in fresh concrete occurs when water from the mix rises to the surface. This happens because the mix's solid components fail to retain all the water as they settle, leading to separation where water collects at the top. The severity of bleeding can be measured by assessing the total settlement or by noting the decrease in height per unit height of concrete.
Bleeding can cause several issues in the concrete structure. Sometimes, the rising water gets trapped beneath large aggregate...
570
Relative Risk01:12

Relative Risk

Relative risk (RR) is a statistical measure commonly used in epidemiology to compare the likelihood of a particular event occurring between two groups. This metric is important for evaluating the relationship between exposure to a specific risk factor and the probability of a particular outcome. It plays a crucial role in medical research, public health studies, and risk assessment. Relative risk quantifies how much more (or less) likely an event is to occur in an exposed group compared to an...
2.1K
Coronary Circulation01:21

Coronary Circulation

The heart, an organ critical to survival, gets nourishment not from the blood it pumps but from a separate circulation system known as coronary circulation. This is the shortest circulation in the body and is responsible for supplying the heart with the nutrients it needs to function effectively.
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
7.1K
Factors Affecting the Risk of Infection01:26

Factors Affecting the Risk of Infection

The hosts' susceptibility to infection depends on several factors. The integrity of the skin and mucous membranes helps protect the body against microbial attacks. When the skin is altered, the chance of infection, limb loss, and even death increases.
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
13.4K
Gene Therapy00:59

Gene Therapy

Gene therapy is a technique where a gene is inserted into a person’s cells to prevent or treat a serious disease. The added gene may be a healthy version of the gene that is mutated in the patient, or it could be a different gene that inactivates or compensates for the patient’s disease-causing gene. For example, in patients with severe combined immunodeficiency (SCID) due to a mutation in the gene for the enzyme adenosine deaminase, a functioning version of the gene can be...
27.6K
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors01:20

Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors

Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
1.2K