1- Versus 3-Month DAPT in Older Patients at a High Bleeding Risk Undergoing PCI: Insights from the XIENCE Short DAPT...

Area of Science:

• Cardiology
• Interventional Cardiology
• Geriatric Medicine

Background:

• Dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention (PCI) is critical for balancing ischemic and bleeding risks.
• Older patients and those with high bleeding risk often face challenges with prolonged DAPT regimens.
• Everolimus-eluting stents (XIENCE) are commonly used, necessitating evidence-based DAPT strategies.

Purpose of the Study:

• To evaluate the comparative effectiveness of 1-month versus 3-month DAPT following PCI in older patients.
• To assess the impact of DAPT duration on ischemic events (all-cause death or myocardial infarction) and bleeding events (BARC type 2-5).
• To determine if age (≥75 vs <75 years) influences the outcomes of shorter DAPT duration in high bleeding risk patients.

Main Methods:

• Analysis of data from three prospective, single-arm studies (XIENCE Short DAPT Program) involving patients with high bleeding risk treated with XIENCE stents.
• Patients were stratified by age (≥75 and <75 years) and randomized to discontinue DAPT at 1 or 3 months post-PCI.
• Primary endpoint: all-cause death or myocardial infarction; Secondary endpoint: Bleeding Academic Research Consortium (BARC) type 2-5 bleeding, assessed up to 12 months.

Main Results:

• A total of 3,364 patients were analyzed, with 66.6% aged ≥75 years.
• The risk of death or MI was similar between 1-month and 3-month DAPT groups in both age strata (≥75 years: 8.5% vs 8.0%; <75 years: 6.9% vs 7.8%).
• 1-month DAPT demonstrated a consistent reduction in BARC type 2-5 bleeding compared to 3-month DAPT across both age groups (≥75 years: 7.2% vs 9.4%; <75 years: 9.7% vs 11.9%).

Conclusions:

• In high bleeding risk patients undergoing PCI with everolimus-eluting stents, a 1-month DAPT regimen is associated with significantly lower bleeding rates compared to a 3-month regimen.
• This reduction in bleeding with shorter DAPT duration was observed in both older (≥75 years) and younger (<75 years) patients.
• A 1-month DAPT strategy provides a favorable safety profile by reducing bleeding without compromising ischemic protection (all-cause death or MI) at 1 year.