Drug-coated Balloons or Drug-eluting Stents - Determining an Optimum Strategy for Patients with High Bleeding Risk

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Managing patients with high bleeding risk undergoing percutaneous coronary intervention (PCI) presents challenges in balancing thrombotic and bleeding risks.
• Determining the optimal duration of dual antiplatelet therapy (DAPT) is crucial for patient safety.
• Drug-eluting stents (DES) and historically bare-metal stents (BMS) have been used, with recent focus on shorter DAPT durations.

Purpose of the Study:

• To review the safety profile and bleeding events associated with drug-coated balloons (DCBs) and DES in high-risk patients.
• To compare the efficacy and safety of DCBs versus DES for PCI in patients requiring shorter DAPT durations.
• To evaluate the feasibility of a 1-month DAPT regimen in this patient population.

Main Methods:

• Systematic literature review of studies comparing DCBs and DES in patients at high bleeding risk.
• Analysis of safety outcomes, focusing on bleeding events and major adverse cardiovascular events (MACE).
• Inclusion of studies investigating 1-month DAPT cessation following stent or balloon implantation.

Main Results:

• Both DCBs and DES have demonstrated the safety of discontinuing DAPT after 1 month in high-risk patients.
• DCBs were associated with a lower incidence of major adverse cardiovascular events compared to DES.
• Bleeding event profiles were comparable or favored DCBs in certain analyses.

Conclusions:

• A 1-month DAPT regimen is a safe option for high-bleeding-risk patients treated with either DCBs or DES.
• Drug-coated balloons represent a potentially superior alternative to drug-eluting stents, offering reduced MACE.
• Further research may solidify DCBs as the preferred treatment for this challenging patient group.