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Sex-Based Differences in the Effect of Short Dual Antiplatelet Therapy Followed by Prasugrel Monotherapy in

Norihiro Kogame1,2, Yoshihisa Nakagawa3, Ken Kozuma4

  • 1Division of Cardiovascular Medicine, Toho University Ohashi Medical Center Tokyo Japan.

Circulation Reports
|April 13, 2026
PubMed

Insights

Short dual antiplatelet therapy (DAPT) followed by prasugrel monotherapy in high bleeding risk patients undergoing percutaneous coronary intervention (PCI) showed numerically lower ischemic and bleeding events. No significant sex-based differences were observed in this study.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • High bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) require careful antiplatelet therapy selection.
  • Short dual antiplatelet therapy (DAPT) strategies aim to reduce bleeding complications post-PCI.
  • The impact of sex on short DAPT strategies, specifically prasugrel monotherapy, remains under investigation.

Purpose of the Study:

  • To evaluate sex-based differences in outcomes of a short DAPT strategy followed by prasugrel monotherapy versus conventional DAPT in HBR patients.
  • To compare major adverse cardiovascular and cerebrovascular events (MACCE) and clinically relevant bleeding (CRB) between the two strategies.
  • To determine if sex influences the efficacy and safety of short DAPT post-PCI.

Main Methods:

  • Analysis of 24-month outcomes from two prospective, non-interventional registries: PENDULUM mono (short DAPT + prasugrel) and PENDULUM (conventional DAPT).
  • Inclusion of 872 patients in the short DAPT group and 1,553 HBR patients in the conventional DAPT group.
  • Application of inverse probability of treatment weighting (IPTW) for comparative analysis of MACCE and CRB (BARC types 2, 3, 5).

Main Results:

  • In women, the short DAPT strategy showed numerically lower MACCE (8.2% vs. 12.3%) and CRB (4.7% vs. 7.0%) compared to conventional DAPT.
  • In men, similar numerical trends were observed for MACCE (8.8% vs. 11.0%) and CRB (7.0% vs. 8.1%).
  • No statistically significant interaction between treatment strategy and sex was found for either MACCE (P=0.599) or CRB (P=0.537).

Conclusions:

  • A short DAPT strategy followed by prasugrel monotherapy demonstrated numerically fewer ischemic and bleeding events in HBR patients undergoing PCI.
  • The study found no evidence of sex-based heterogeneity in the treatment effects of the short DAPT strategy.
  • These findings suggest that short DAPT with prasugrel monotherapy is a potentially safe and effective strategy for HBR patients, irrespective of sex.
Abstract

Keywords:
Antiplatelet therapyDrug-eluting stentsHigh bleeding riskPercutaneous coronary interventionSex differences

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