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One- versus three-month dual antiplatelet therapy in high bleeding risk patients undergoing percutaneous coronary

Davide Cao1,2, Pascal Vranckx3, Marco Valgimigli4,5

  • 1Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|May 22, 2024
PubMed

Insights

Short dual antiplatelet therapy (DAPT) is safe for high bleeding risk patients after drug-eluting stent implantation. One month of DAPT, compared to three months, showed similar ischemic risk and reduced bleeding events at one year.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Short dual antiplatelet therapy (DAPT) is a proposed strategy for patients at high bleeding risk (HBR) undergoing drug-eluting stent (DES) implantation.
  • The safety and efficacy of abbreviated DAPT after non-ST-segment elevation acute coronary syndrome (NSTE-ACS) require further investigation.

Purpose of the Study:

  • To compare the clinical outcomes of 1-month versus 3-month DAPT in HBR patients after DES implantation.
  • To assess outcomes in both NSTE-ACS and non-NSTE-ACS patient subgroups.

Main Methods:

  • Analysis of data from three prospective, international, single-arm studies (XIENCE Short DAPT programme).
  • Evaluation of 1-month (XIENCE 28) versus 3-month (XIENCE 90) DAPT in HBR patients receiving cobalt-chromium everolimus-eluting stents.
  • Propensity score stratification was used to compare ischemic and bleeding outcomes based on clinical presentation.

Main Results:

  • In 3,364 HBR patients, 1-month DAPT showed similar rates of death or myocardial infarction compared to 3-month DAPT at 12 months, regardless of NSTE-ACS presence.
  • Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding was significantly reduced with 1-month DAPT in NSTE-ACS patients (HR 0.57) and showed a similar trend in stable patients (HR 0.84).

Conclusions:

  • One-month DAPT is associated with similar ischemic risk and reduced bleeding compared to 3-month DAPT in HBR patients after everolimus-eluting stent implantation.
  • This finding holds true irrespective of the patient's clinical presentation, including NSTE-ACS.
Abstract

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