DAPT Duration After PCI in High Bleeding Risk: Key Points

Dec 12, 2022   |  Bina Ahmed, MD, FACC
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Authors:
Costa F, Montalto C, Branca M, et al.
Citation:
Dual Antiplatelet Therapy Duration After Percutaneous Coronary Intervention in High Bleeding Risk: A Meta-Analysis of Randomized Trials. Eur Heart J 2022;Dec 7:[Epub ahead of print].

The following are key points to remember from this systematic review and meta-analysis of dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention (PCI) in high bleeding risk (HBR):

  1. An analysis from this comprehensive meta-analysis of randomized clinical trials evaluated the optimal duration of DAPT (1 month, 3 months vs. ≥6 months; followed by single antiplatelet therapy) among patients with HBR undergoing PCI.
  2. “High bleeding risk” (HBR) was defined using the PRECISE-DAPT score of ≥25 or HBR based on the HBR-ARC definition.
  3. Regardless of score used, patients at HBR who received abbreviated 1 month or 3 months of DAPT had a 24% reduction in major or non–clinically relevant bleeding, 20% reduction in major bleeding, and 21% reduction in cardiovascular-related death without a significant increase in major adverse cardiovascular events compared to ≥6 months of DAPT.
  4. Findings persisted regardless of presentation (acute coronary syndrome [ACS] vs. no ACS).
  5. No difference in effect was seen with choice of aspirin or P2Y12 inhibitor after DAPT.
  6. Data were unable to show superiority of one stent platform over another; however, findings suggest that biodegradable/nonpolymer stents, with a reduced time exposure to the potentially thrombogenic polymer material, might be safer in an abbreviated DAPT environment. This observation needs confirmation in dedicated randomized studies.
  7. Current guidelines recommend 3 or 6 months of DAPT in HBR patients undergoing PCI for ACS or chronic coronary syndrome. This may need to be re-evaluated based on findings from this meta-analysis.
  8. Findings support the idea that DAPT duration should be adjusted based on patient characteristics, and bleeding rather than ischemic risk should be prioritized in HBR patients.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Prevention, Interventions and ACS

Keywords: Acute Coronary Syndrome, Aspirin, Hemorrhage, Myocardial Ischemia, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Polymers, Receptors, Purinergic P2Y12, Risk, Secondary Prevention, Stents


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