1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI

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Marco Valgimigli1, Alessandro Spirito2, Samantha Sartori2

  • 1Cardiocentro Ticino Institue, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland.

JACC. Cardiovascular Interventions
|October 7, 2023
PubMed

Insights

Shorter dual antiplatelet therapy (DAPT) of 1 month, compared to 3 months, showed similar risks for death or myocardial infarction (MI) in patients on oral anticoagulation (OAC). One-month DAPT also significantly reduced bleeding events, regardless of OAC use.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Pharmacology

Background:

  • Optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients on long-term oral anticoagulation (OAC) is not well-established.
  • Patients on OAC often have high bleeding risk, complicating antiplatelet therapy decisions post-PCI.

Purpose of the Study:

  • To evaluate the comparative effectiveness and safety of 1-month versus 3-month DAPT in patients undergoing PCI with a cobalt-chromium everolimus-eluting stent.
  • To specifically assess outcomes in patients with and without concomitant OAC therapy within the XIENCE Short DAPT program.

Main Methods:

  • Analysis of the XIENCE Short DAPT program, enrolling high bleeding risk patients post-PCI.
  • Comparison of 1-month vs. 3-month DAPT discontinuation in patients free from ischemic events.
  • Propensity score stratification used to compare outcomes (all-cause death, MI, BARC 2-5 bleeding) between 1- and 3-month DAPT groups, with and without OAC.

Main Results:

  • Among patients on OAC, 1-month DAPT showed similar rates of death or MI compared to 3-month DAPT (7.4% vs. 8.8%; P=0.139).
  • One-month DAPT significantly reduced Bleeding Academic Research Consortium (BARC) types 2-5 bleeding in OAC patients (adjusted HR: 0.71; P=0.046).
  • These findings were consistent across patients with and without OAC, indicating no significant interaction.

Conclusions:

  • A 1-month DAPT duration is associated with similar ischemic event rates but lower bleeding rates compared to 3-month DAPT after PCI in high bleeding risk patients.
  • These benefits of shorter DAPT duration are maintained irrespective of concomitant oral anticoagulation therapy.
Abstract

Keywords:
dual antiplatelet therapyeverolimus-eluting stent(s)high bleeding riskoral anticoagulant therapypercutaneous coronary intervention

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