PARIS: Does DAPT Cessation After PCI Increase Cardiac Risk?
The impact of dual antiplatelet therapy (DAPT) cessation on cardiac risk after PCI is not uniform but varies substantially based on the underlying reasons for cessation, according to the PARIS Study presented on Sept. 1 during the ESC Congress 2013 and simultaneously published in the Lancet.
In terms of major adverse cardiac events (MACE), the overall rate over the two-year period was 11 percent, with most events (74 percent) occurring while patients were taking DAPT. The adjusted hazard ratio (HR) for MACE due to short-term interruption was 1.41 (p=0·10) and to disruption for noncompliance or bleeding was 1.50 (p=0•004). In contrast, patients who discontinued DAPT per their physician had lower MACE risk (0.63). "The overall impact of DAPT cessation on adverse events is modest and may have been mitigated with the introduction of safer stent platforms," the investigators noted.
In a corresponding commentary, Andreas May, MD, from University Hospital Tubingen and Eberhard Karls-University, Germany, writes that the PARIS results on the one hand show "there is adequate safety for patients who complete or temporarily interrupt DAPT in accordance with their physician's recommendation." However, he says, "on the other hand, unanticipated disruptions of antiplatelet therapy put the patient at increased risk and necessitate the best care and alertness by treating physicians."
Moving forward, the study investigators suggest their findings "highlight the need for uniform approaches in classifying DAPT cessation, analogous to those currently used for bleeding and MI."
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