Related Experiment Video
Updated: Aug 3, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Abbreviated or Standard Antiplatelet Therapy in HBR Patients: Final 15-Month Results of the MASTER-DAPT Trial
Antonio Landi1, Dik Heg2, Enrico Frigoli3
1Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Università della Svizzera Italiana, Lugano, Switzerland. Electronic address: https://twitter.com/antoniolandii.
Insights
In high bleeding risk patients undergoing percutaneous coronary intervention, abbreviated antiplatelet therapy (APT) showed similar net adverse clinical outcomes (NACE) and major adverse cardiac and cerebral events (MACCE) compared to standard APT. Abbreviated APT significantly reduced bleeding events at 15 months.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Clinical outcomes after completing antiplatelet therapy (APT) following percutaneous coronary intervention (PCI) are not well-established.
- The MASTER DAPT trial investigated treatment selection and outcomes in high bleeding risk patients post-PCI.
Purpose of the Study:
- To assess 15-month and 12-to-15-month outcomes after PCI during routine care in the MASTER DAPT trial.
- To compare abbreviated versus standard APT regimens in high bleeding risk patients.
Main Methods:
- The MASTER DAPT trial randomized 4,579 high bleeding risk patients to abbreviated or standard APT.
- Coprimary outcomes included net adverse clinical outcomes (NACE), major adverse cardiac and cerebral events (MACCE), and Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding.
Main Results:
- At 15 months, NACE and MACCE did not differ between abbreviated and standard APT groups.
- Abbreviated APT was associated with significantly lower rates of BARC 2, 3, or 5 bleeding (P=0.0001).
- Routine care treatment effects were consistent with findings within 12 months post-PCI.
Conclusions:
- In high bleeding risk patients, abbreviated APT did not increase NACE or MACCE compared to standard APT at 15 months.
- Abbreviated APT significantly reduced major or clinically relevant nonmajor bleeding events.
- The findings support the use of abbreviated APT in select high bleeding risk patients post-PCI.
Background:
Clinical outcomes and treatment selection after completing the randomized phase of modern trials, investigating antiplatelet therapy (APT) after percutaneous coronary intervention (PCI), are unknown.
Objectives:
The authors sought to investigate cumulative 15-month and 12-to-15-month outcomes after PCI during routine care in the MASTER DAPT trial.
Methods:
The MASTER DAPT trial randomized 4,579 high bleeding risk patients to abbreviated (n = 2,295) or standard (n = 2,284) APT regimens. Coprimary outcomes were net adverse clinical outcomes (NACE) (all-cause death, myocardial infarction, stroke, and BARC 3 or 5 bleeding); major adverse cardiac and cerebral events (MACCE) (all-cause death, myocardial infarction, and stroke); and BARC type 2, 3, or 5 bleeding.
Results:
At 15 months, prior allocation to a standard APT regimen was associated with greater use of intensified APT; NACE and MACCE did not differ between abbreviated vs standard APT (HR: 0.92 [95% CI: 0.76-1.12]; P = 0.399 and HR: 0.94 [95% CI: 0.76-1.17]; P = 0.579; respectively), as during the routine care period (HR: 0.81 [95% CI: 0.50-1.30]; P = 0.387 and HR: 0.74 [95% CI: 0.43-1.26]; P = 0.268; respectively). BARC 2, 3, or 5 was lower with abbreviated APT at 15 months (HR: 0.68 [95% CI: 0.56-0.83]; P = 0.0001) and did not differ during the routine care period. The treatment effects during routine care were consistent with those observed within 12 months after PCI.
Conclusions:
At 15 months, NACE and MACCE did not differ in the 2 study groups, whereas the risk of major or clinically relevant nonmajor bleeding remained lower with abbreviated compared with standard APT. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020).
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:27Coronary Artery Disease V: Interprofessional Care
01:26Atherosclerosis III: Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...