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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Short dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk patients:

Kevin R Bainey1, Guillaume Marquis-Gravel2, Blair J MacDonald3

  • 1Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta.

Plos One
|September 1, 2023
PubMed

Insights

Short dual antiplatelet therapy (DAPT) for 1-3 months in high bleeding risk patients undergoing percutaneous coronary intervention (PCI) significantly reduces bleeding events. This shorter duration is safe, not increasing ischemic risks like MACE or stent thrombosis.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Pharmacology

Background:

  • Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is crucial for preventing stent thrombosis and major adverse cardiovascular events (MACE).
  • Determining optimal DAPT duration is challenging, particularly for high bleeding risk (HBR) patients, where prolonged therapy increases bleeding complications.

Approach:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted, including five RCTs with 7,242 patients.
  • The study compared short DAPT (1-3 months) versus standard DAPT (6-12 months) in HBR patients post-PCI.
  • Outcomes assessed included MACE, all-cause death, stent thrombosis, major bleeding, and clinically relevant non-major bleeding, with risk of bias and certainty of evidence evaluated.

Key Points:

  • Short DAPT (1-3 months) did not increase the risk of MACE, all-cause death, or stent thrombosis compared to standard DAPT (6-12 months).
  • Short DAPT significantly reduced major bleeding events (RR 0.34) and the composite of major or clinically-relevant non-major bleeding (RR 0.60).
  • This translates to a reduction of 21 and 34 bleeding events per 1000 patients, respectively.

Conclusions:

  • In high bleeding risk patients undergoing PCI, a DAPT duration of 1-3 months is effective in reducing bleeding events.
  • Short DAPT can be safely implemented in HBR patients without compromising ischemic protection.
  • Consideration of shorter DAPT durations is recommended for HBR patients receiving PCI.
Abstract

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