Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk
Why the study?
The appropriate duration of dual antiplatelet therapy in patients at high risk for bleeding after drug-eluting coronary stent implantation remains unclear.
Does abbreviated dual antiplatelet therapy (1 month) reduce bleeding without increasing ischemic events compared to standard therapy (≥3 months) in high bleeding risk patients after PCI?
Population
4579 high bleeding risk patients 1 month after biodegradable-polymer sirolimus-eluting stent implantation
Comparison
Immediate DAPT discontinuation vs continuation for at least 2 additional months
Design
Randomized noninferiority and superiority trial
Follow-up
335 days
Authors
Discussion
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Member takes
Implication
Abbreviated DAPT is preferable in high-bleeding-risk PCI; confirms and extends RCT evidence favoring shorter regimens.
Structured PICO
Does abbreviated dual antiplatelet therapy (1 month) reduce bleeding without increasing ischemic events compared to standard therapy (≥3 months) in high bleeding risk patients after PCI?
P
Population
4,579 patients at high bleeding risk 1 month after undergoing implantation of a biodegradable-polymer sirolimus-eluting coronary stent
I
Intervention
Discontinuation of dual antiplatelet therapy immediately at 1 month post-PCI (abbreviated therapy)
C
Comparator
Continuation of dual antiplatelet therapy for at least 2 additional months (standard therapy)
O
Outcome
Three ranked primary outcomes assessed at 335 days: 1) net adverse clinical events (composite of death from any cause, myocardial infarction, stroke, or major bleeding), 2) major adverse cardiac or cerebral events (composite of death from any cause, myocardial infarction, or stroke), and 3) major or clinically relevant nonmajor bleedingcomposite
In patients at high bleeding risk undergoing PCI, 1 month of dual antiplatelet therapy is noninferior to standard therapy for ischemic events while significantly reducing bleeding complications.
Cite This Study
Valgimigli et al. (2021) studied this question.