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Dual antiplatelet therapy after percutaneous coronary intervention in patients at high bleeding risk: A systematic

Yan Han1, Xiaohang Yuan1, Xin Hu1

  • 1Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China.

Cardiology Journal
|August 1, 2022
PubMed

Insights

Shortening dual antiplatelet therapy (DAPT) to 3 months or less in high bleeding risk (HBR) patients after stenting reduces major bleeding events. This approach is safe and effective, with no significant increase in stent thrombosis or myocardial infarction risks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Determining optimal dual antiplatelet therapy (DAPT) duration for high bleeding risk (HBR) patients post-percutaneous coronary intervention (PCI) remains unclear.
  • This study investigates the safety and efficacy of short-term DAPT (≤ 3 months) in HBR patients receiving new-generation drug-eluting stents (DES).

Approach:

  • A systematic review and meta-analysis of studies published up to November 2021.
  • Included five observational studies and one randomized controlled trial, encompassing 15,432 HBR patients.
  • Analyzed primary endpoints of major bleeding, stent thrombosis (ST), and myocardial infarction (MI), alongside secondary endpoints of all-cause death and ischemic stroke.

Key Points:

  • Short DAPT (≤ 3 months) significantly reduced major bleeding compared to standard DAPT (> 3 months) in HBR patients (2.3% vs. 3.2%, p=0.03).
  • No significant differences were observed in definite/probable ST (0.4% vs. 0.3%) or MI (2.4% vs. 2.0%) between short and standard DAPT durations.
  • The findings suggest a favorable safety and efficacy profile for shorter DAPT durations in this patient cohort.

Conclusions:

  • Short-term DAPT (≤ 3 months) is associated with reduced major bleeding in HBR patients with new-generation DES.
  • This strategy does not significantly elevate the risks of stent thrombosis or myocardial infarction.
  • Shortening DAPT duration is a viable option for managing HBR patients undergoing PCI.
Abstract

Keywords:
dual antiplatelet therapydurationhigh bleeding risknew-generation stentpercutaneous coronary intervention

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