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1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful

Shuai Zhao1,2, Boda Zhu3, Yan Chen4

  • 1Department of Cardiology, Air Force Hospital of Western Theater Command, Chengdu, 610000, Sichuan, China.

Drugs & Aging
|August 2, 2025
PubMed

Insights

Short-term dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) in chronic total occlusion percutaneous coronary intervention (CTO-PCI) patients showed similar cardiovascular benefits but reduced bleeding risk compared to long-term DAPT.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Pharmacology

Background:

  • Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI).
  • Short-term DAPT followed by single antiplatelet therapy (SAPT) reduces bleeding risk in coronary heart disease (CHD) patients.
  • The efficacy of this strategy in chronic total occlusion PCI (CTO-PCI) remains under investigation.

Purpose of the Study:

  • To prospectively evaluate the safety and efficacy of a 1-month DAPT regimen followed by SAPT versus standard long-term DAPT in patients undergoing CTO-PCI.
  • To compare rates of major adverse cardiovascular events (MACE) and bleeding between the two antiplatelet strategies.

Main Methods:

  • A prospective study of 701 patients undergoing successful elective CTO-PCI from April 2019 to May 2021.
  • Patients received 1-month DAPT, then were randomized to SAPT (clopidogrel or ticagrelor) or continued DAPT.
  • One-year follow-up data on MACE and bleeding (BARC types 1-5) were collected.

Main Results:

  • No significant difference in MACE incidence between SAPT (14.5%) and DAPT (15.4%) groups (p=0.742).
  • The SAPT group had a significantly lower rate of minor bleeding (BARC types 1 or 2; 2.3% vs 12.7%, p<0.001).
  • No significant difference in major bleeding (BARC types 3 or 5) was observed between groups (2.3% vs 1.2%, p=0.261).

Conclusions:

  • One-month DAPT followed by SAPT is a safe and effective strategy in CTO-PCI patients.
  • This regimen significantly reduces bleeding risk without compromising cardiovascular outcomes compared to standard 12-month DAPT.
  • Short-term DAPT followed by SAPT offers a favorable risk-benefit profile for CTO-PCI.
Abstract

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