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One-Month Dual Antiplatelet Therapy Reduces Major Bleeding Compared With Longer-Term Treatment Without Excess Stent
Gani Bajraktari1, Ibadete Bytyçi1, Genc Abdyli2
1Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo.
Insights
Short dual antiplatelet therapy (DAPT) after drug-eluting stent percutaneous coronary intervention (PCI) significantly reduces major bleeding. This approach maintains similar safety regarding stent thrombosis and mortality compared to longer DAPT durations.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
- Optimizing DAPT duration is crucial to balance efficacy and safety, particularly reducing bleeding risk.
Purpose of the Study:
- To evaluate the clinical safety and efficacy of a 1-month DAPT regimen followed by single antiplatelet therapy (aspirin or P2Y12 inhibitor) compared to longer DAPT durations in patients undergoing PCI with DES.
- To assess the impact of shorter DAPT on major bleeding, stent thrombosis, and other cardiovascular events.
Main Methods:
- A meta-analysis of 5 randomized controlled trials involving 29,831 patients who underwent PCI with DES.
- Comparison between 1-month DAPT and >1-month DAPT regimens.
- Primary endpoints: major bleeding and stent thrombosis. Secondary endpoints: mortality, myocardial infarction, stroke, and major adverse cardiovascular or cerebrovascular events.
Main Results:
- 1-month DAPT was associated with a significantly lower rate of major bleeding (OR 0.66, 95% CI 0.45 to 0.97, p=0.03).
- Stent thrombosis rates were similar between the 1-month and >1-month DAPT groups (OR 1.08, 95% CI 0.81 to 1.44).
- Major adverse cardiovascular or cerebrovascular events were also lower with 1-month DAPT (OR 0.86, 95% CI 0.76 to 0.97, p=0.02).
Conclusions:
- A 1-month DAPT regimen followed by aspirin or a P2Y12 receptor inhibitor is safe and effective after PCI with DES.
- This shorter DAPT duration reduces major bleeding without increasing thrombotic risk compared to longer durations.
- Clinical practice guidelines may consider shorter DAPT durations to improve patient safety.
Abstract:
Dual antiplatelet therapy (DAPT) remains the gold standard in patients who underwent percutaneous coronary intervention (PCI). This meta-analysis aims to evaluate the clinical safety of 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor after PCI with drug-eluting stents (DES). We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar, Cochrane Central Registry, and ClinicalTrials.gov databases and identified 5 randomized controlled trials with 29,831 patients who underwent PCI with DES and compared 1-month versus >1-month DAPT. The primary end point was major bleeding, and the co-primary end point was stent thrombosis. The secondary end point included all-cause mortality, cardiovascular death, myocardial infarction, stroke, and major adverse cardiovascular or cerebrovascular events. Compared with >1-month DAPT, the 1-month DAPT was associated with a lower rate of major bleeding (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.45 to 0.97, p = 0.03, I2 = 71%), whereas stent thrombosis had a similar rate in both study groups (OR 1.08, 95% CI 0.81 to 1.44, p = 0.60, I2 = 0.0%). The study groups had similar risks for all-cause mortality (OR 0.89, 95% CI 0.77 to 1.04, p = 0.14, I2 = 0.0%), cardiovascular death (OR 0.84, 95% CI 0.59 to 1.19, p = 0.32, I2 = 0.0%), myocardial infarction (OR 1.04, 95% CI 0.89 to 1.21, p = 0.62, I2 = 0.0%), and stroke (OR 0.82, 95% CI 0.64 to 1.05, p = 0.11, I2 = 6%). The risk of major adverse cardiovascular or cerebrovascular events was lower (OR 0.86, 95% CI 0.76 to 0.97, p = 0.02, I2 = 25%) in the 1-month DAPT compared with >1-month DAPT. In conclusion, in patients who underwent PCI with DES, 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor reduced major bleeding with no risk of increased thrombotic risk compared with longer-term DAPT.
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