Key result
Short DAPT with prasugrel monotherapy shows no MACCE benefit over conventional DAPT in HBR PCI.
Why the study?
Sex-based differences in the effects of a short DAPT strategy followed by prasugrel monotherapy compared with a conventional DAPT strategy remain unclear in patients at high bleeding risk after PCI.
Does a short DAPT strategy followed by prasugrel monotherapy reduce MACCE and clinically relevant bleeding compared to conventional DAPT in high-bleeding-risk patients after PCI, and does this effect differ by sex?
Cohort (n=2,425)
Yes
Does a short DAPT strategy followed by prasugrel monotherapy reduce MACCE and clinically relevant bleeding compared to conventional DAPT in high-bleeding-risk patients after PCI, and does this effect differ by sex?
Hazard Ratio: 0.71 (95% CI 0.42–1.2)
Absolute Event Rate: 8.2% vs 12.3%
p-value: p=0.197
Short DAPT followed by prasugrel monotherapy appears similarly effective and safe in both men and women with high bleeding risk undergoing PCI.
Supports sex-independent short DAPT plus prasugrel monotherapy after high-bleeding-risk PCI; leaves open randomized confirmation before practice change.
Background: In patients at high bleeding risk (HBR), short dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) reduces bleeding without increasing ischemic events. However, the sex-based differences in the effects of short DAPT strategy followed by prasugrel monotherapy compared with conventional DAPT strategy remain unclear. Methods and Results: The 24-month outcomes from 2 multicenter, non-interventional, prospective registries, PENDULUM mono (n=872; short DAPT strategy followed by prasugrel monotherapy) and an HBR subset of the PENDULUM registry (n=1,553; conventional DAPT strategy), were analyzed using the inverse probability of treatment weighting method. Primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE) and clinically relevant bleeding (CRB: Bleeding Academic Research Consortium [BARC] types 2, 3, and 5). In women, short DAPT strategy was associated with numerically lower rates of MACCE (8.2% vs. 12.3%; hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.42-1.20; P=0.197) and CRB (4.7% vs. 7.0%; HR 0.68, 95% CI 0.35-1.32; P=0.258). In men, similar trends were observed for MACCE (8.8% vs. 11.0%; HR 0.86, 95% CI 0.62-1.21; P=0.388) and CRB (7.0% vs. 8.1%; HR 0.87, 95% CI 0.60-1.26; P=0.460). No significant interaction between treatment and sex was found for MACCE (P=0.599) or CRB (P=0.537). Conclusions: In HBR patients undergoing PCI, a short DAPT strategy followed by prasugrel monotherapy had numerically fewer ischemic and bleeding events than conventional DAPT strategy, without evidence of sex-based heterogeneity.
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Kogame et al. (2026) conducted a cohort in High bleeding risk after percutaneous coronary intervention (n=2,425). Short dual antiplatelet therapy followed by prasugrel monotherapy vs. Conventional dual antiplatelet therapy was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) in women (HR 0.71, 95% CI 0.42-1.20, p=0.197). A short dual antiplatelet therapy strategy followed by prasugrel monotherapy was associated with numerically lower rates of major adverse cardiovascular and cerebrovascular events compared to conventional therapy in both women (HR 0.71) and men (HR 0.86) with high bleeding risk after percutaneous coronary intervention, with no significant interaction by sex.
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