One- and three-month dual antiplatelet therapy (DAPT) was found to have similar risk for ischemic events in both women and men at high bleeding risk undergoing PCI, according to a study published March 5 in JACC: Cardiovascular Interventions.

Including 3,364 patients (34.3% women) at high bleeding risk undergoing PCI with fluoropolymer-based cobalt-chromium everolimus-eluting stents from three prospective studies, Vijay Kunadian, MD, Roxana Mehran, MD, FACC, et al., compared one-month vs. three-month DAPT regimens followed by aspirin monotherapy. The study's primary endpoint was composite death or myocardial infarction (MI) at one year.

For men and women, rates of death or MI (7.6% vs. 8.1%) were similar. One-month and three-month DAPT resulted in similar risk for death or MI in women (adjusted hazard ratio [HR], 0.86; 95% CI, 0.54-1.36) as well as men (adjusted HR, 1.04; 95% CI, 0.75-1.44) (p for interaction=0.783).

The authors also analyzed Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding as a secondary endpoint. BARC types 2 to 5 bleeding were also similar in men and women (9.5% vs. 9.2%). While BARC types 2 to 5 bleeding were numerically lower with one-month DAPT vs. three-month DAPT in both men and women, these findings were not statistically significant (women: 7.1% vs. 11.2%; adjusted HR, 0.66; 95% CI, 0.43-1.02; men: 8.5% vs. 9.7%; adjusted HR, 0.78; 95% CI, 0.57-1.06) (p for interaction=0.378).

"Patient selection for [one]-month vs. [three]-month DAPT requires careful attention to individual ischemic and bleeding risks," write the authors, "and further studies are needed to assess the efficacy and safety of the [two] short DAPT regimens in women and men with [STEMI] and with more anatomically complex disease."

In an accompanying editorial comment, Jaya Chandrasekhar, MBBS, MS, PhD, adds: "Women at [high bleeding risk] should not be denied the benefits of revascularization. Women and men at [high bleeding risk] have similar key outcomes, and it is feasible to use short-term DAPT without penalty from serious ischemic events."