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Duration of Dual Antiplatelet Therapy for Patients at High Bleeding Risk Undergoing PCI

Marco Valgimigli1, Davide Cao2, Dominick J Angiolillo3

  • 1Cardiocentro Ticino Institue, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland.

Journal of the American College of Cardiology
|November 19, 2021
PubMed

Insights

For high bleeding risk patients undergoing percutaneous coronary intervention, one month of dual antiplatelet therapy (DAPT) showed similar ischemic outcomes and reduced bleeding compared to three months of DAPT.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in high bleeding risk (HBR) patients remains unclear.
  • Current guidelines lack definitive recommendations for DAPT duration in HBR patients post-PCI.
  • Balancing ischemic event prevention and bleeding risk is critical in HBR patients.

Purpose of the Study:

  • To compare the efficacy and safety of 1-month versus 3-month DAPT regimens in HBR patients undergoing PCI with drug-eluting stents.
  • To evaluate ischemic and bleeding outcomes in HBR patients treated with different DAPT durations.
  • To inform clinical decision-making regarding DAPT duration in HBR populations.

Main Methods:

  • Exploratory analysis of the XIENCE Short DAPT program, including three prospective, single-arm studies.
  • Propensity score stratification was used to compare patients receiving 1-month DAPT (XIENCE 28 USA and Global) versus 3-month DAPT (XIENCE 90).
  • Assessment of ischemic (all-cause mortality, myocardial infarction) and bleeding (BARC types 2-5, 3-5) outcomes up to 12 months post-PCI.

Main Results:

  • The primary endpoint of all-cause mortality or myocardial infarction was similar between the 1-month and 3-month DAPT groups (7.3% vs 7.5%).
  • The key secondary endpoint of BARC type 2-5 bleeding was significantly lower in the 1-month DAPT group compared to the 3-month DAPT group (7.6% vs 10.0%, P=0.012).
  • While major BARC type 3-5 bleeding did not differ significantly at 12 months, it was lower at 90 days with 1-month DAPT (1.0% vs 2.1%, P=0.015).

Conclusions:

  • One month of DAPT in HBR patients undergoing PCI with everolimus-eluting stents is associated with similar ischemic event rates compared to three months of DAPT.
  • A shorter DAPT duration of 1 month significantly reduces bleeding risk in HBR patients post-PCI.
  • These findings suggest that a 1-month DAPT regimen may be a viable option for HBR patients, warranting further investigation.
Abstract

Keywords:
bleedingeverolimus-eluting stenthigh bleeding riskshort DAPTthrombosis

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