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Timing of Bleeding and Ischemic Events in High-Bleeding Risk Patients Treated With 1-Month DAPT
Guillaume Marquis-Gravel1, Davide Cao2, Dylan Taylor3
1Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
Insights
In high bleeding risk patients after PCI on 1-month dual antiplatelet therapy, bleeding and ischemic risks are highest initially. Major adverse cardiovascular events (MACE) consistently outweigh bleeding risk after the first month.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Percutaneous coronary intervention (PCI) requires careful antiplatelet therapy selection, especially in high bleeding risk (HBR) patients.
- Optimizing treatment strategies necessitates understanding the evolving risks of bleeding versus ischemic events after PCI.
Purpose of the Study:
- To characterize the temporal relationship between bleeding and ischemic events in HBR patients treated with a 1-month dual antiplatelet therapy (DAPT) regimen post-PCI.
- To inform dynamic treatment strategies by analyzing event timing over one year.
Main Methods:
- Analysis of patient-level data from seven prospective studies involving HBR patients undergoing PCI and treated with 1-month DAPT.
- Evaluation of the timing of major bleeding events (Bleeding Academic Research Consortium types 3-5) and major adverse cardiovascular events (MACE).
Main Results:
- In 7,266 HBR patients, 4.0% experienced major bleeding and 6.0% had MACE within one year.
- The highest rates for both bleeding and MACE occurred within the first 30 days post-PCI.
- After 30 days, MACE rates were consistently higher than bleeding rates, with event rates stabilizing over time.
Conclusions:
- For HBR patients on 1-month DAPT post-PCI, the initial 30 days present the highest combined risk for bleeding and MACE.
- Ischemic events (MACE) are more frequent than bleeding events after the first month, suggesting a potential for de-escalation of therapy.
Background:
Understanding the concomitant evolution of bleeding vs ischemic risk after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) treated with 1-month dual antiplatelet therapy (DAPT) would help optimize dynamic treatment strategies.
Objectives:
The aim of this study was to describe the timing of bleeding and ischemic events during 1 year after PCI in this population.
Methods:
Timings of major bleeding events and of major adverse cardiovascular events (MACE) were analyzed in patient-level data from 7 prospective studies including HBR patients treated with PCI and 1-month DAPT.
Results:
Among 7,266 patients (mean age 76 ± 9.0 years, 31.5% women), Bleeding Academic Research Consortium (BARC) types 3 to 5 bleeding occurred in 284 (4.0%), with 73 (1.0%) occurring ≤30 days after and 211 (2.9%) >30 days after index PCI. MACE occurred in 433 patients (6.0%), among which 64 (0.9%) occurred ≤30 days after index PCI and 369 (5.1%) after 30 days. During the first 30 days, there was no significant difference between rates of MACE and BARC types 3 to 5 bleeding events (22.3% vs 25.7%; P = 0.407). However, MACE rates were significantly higher than rates of BARC types 3 to 5 bleeding between 31 and 90 days (7.2% vs 4.9%; P = 0.024) and between 91 and 365 days (5.3% vs 3.1%; P < 0.001) CONCLUSIONS: Among HBR patients undergoing PCI treated with 1-month DAPT, the risk for major bleeding and MACE is highest in the first 30 days. MACE remain consistently more frequent than bleeding after the first month, when event rates stabilize over time while on single antiplatelet therapy.
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