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Short dual antiplatelet therapy in patients with high bleeding risk undergoing percutaneous coronary intervention: a

Junyan Zhang1, Zhongxiu Chen1, Chen Li1

  • 1Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.

Coronary Artery Disease
|September 30, 2022
PubMed

Insights

Shortening dual antiplatelet therapy (DAPT) to 1 or 6 months is safe for high bleeding risk patients after PCI. A 6-month DAPT regimen reduces bleeding risk without increasing major adverse cardiac events.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention (PCI) in high bleeding risk (HBR) patients is debated.
  • Optimizing DAPT duration is crucial to balance ischemic and bleeding risks.

Purpose of the Study:

  • To evaluate the efficacy and safety of abbreviated DAPT durations in HBR patients undergoing PCI.
  • To compare short-term DAPT regimens (1, 3, and 6 months) against longer durations regarding clinical outcomes.

Main Methods:

  • A systematic literature search was conducted across major databases (Cochrane, PubMed, EMBASE, Ovid MEDLINE).
  • Meta-analysis of nine studies (10 cohorts) involving PCI-HBR patients comparing different DAPT durations.
  • Outcomes assessed included major adverse cardiac events (MACE) and net adverse clinical events (NACE).

Main Results:

  • One-month DAPT showed comparable risks of NACE and MACE versus longer durations (>1 month).
  • Three-month DAPT did not increase MACE but elevated risks of ischemic stroke and stent thrombosis compared to >3 months.
  • Six-month DAPT reduced major bleeding risk without increasing NACE or MACE compared to >6 months.

Conclusions:

  • Shortened DAPT to 1 or 6 months is associated with comparable MACE risk in PCI-HBR patients.
  • A 6-month DAPT regimen effectively reduces major bleeding risk.
  • While generally beneficial, a 3-month DAPT regimen showed an increased risk of ischemic stroke.
Abstract

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