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Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of

Francesco Costa1, Claudio Montalto2, Mattia Branca3

  • 1Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinic 'G. Martino', Messina 98100, Italy.

European Heart Journal
|December 8, 2022
PubMed

Insights

Shorter dual antiplatelet therapy (DAPT) durations of 1 or 3 months significantly reduce bleeding and cardiovascular mortality in high bleeding risk patients after percutaneous coronary intervention. These abbreviated regimens do not increase ischemic event risk compared to standard longer durations.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Optimal duration of dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) for high bleeding risk (HBR) patients remains uncertain.
  • Existing evidence is synthesized to evaluate abbreviated DAPT regimens in HBR populations.

Approach:

  • A systematic review and meta-analysis of randomized clinical trials was conducted.
  • Included trials compared abbreviated (1 or 3 months) DAPT with standard (≥6 months) DAPT in HBR patients without need for oral anticoagulation.
  • Data from 11 trials involving 9006 patients were analyzed.

Key Points:

  • Abbreviated DAPT significantly reduced major or clinically relevant non-major bleeding (RR: 0.76) and major bleeding (RR: 0.80).
  • Cardiovascular mortality was also lower with abbreviated DAPT (RR: 0.79).
  • No significant differences were observed in all-cause mortality, major adverse cardiovascular events, myocardial infarction, or stent thrombosis.

Conclusions:

  • In HBR patients undergoing PCI, 1- or 3-month DAPT regimens are associated with reduced bleeding and cardiovascular mortality.
  • These shorter DAPT durations do not appear to increase ischemic event risk compared to standard ≥6-month regimens.
  • Findings were consistent across different HBR definitions and clinical presentations.
Abstract

Keywords:
AspirinDual antiplatelet therapyHigh bleeding riskMonotherapyP2Y12 inhibitorPercutaneous coronary intervention

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