A New Strategy for Discontinuation of Dual Antiplatelet Therapy
Why the study?
There were few prospective randomized clinical studies comparing the safety and efficacy of shorter duration DAPT after DES implantation.
Does 3-month DAPT following E-ZES implantation provide noninferior outcomes compared to 12-month DAPT following other DES implantation in patients with coronary artery stenosis?
Population
2,117 patients with coronary artery stenosis
Comparison
E-ZES plus 3-month DAPT vs other DES plus 12-month DAPT
Design
Prospective randomized noninferiority trial
Follow-up
1 year
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“With newer-generation DES, 6 months DAPT might be sufficient, and 3 months not completely off the wall in low-risk groups. Brief interruption of DAPT beyond 4 weeks might not be associated with a dramatic risk increase. However, the patient- and device-related criteria safely allowing early DAPT withdrawal or interruption still have to be determined. Until then, we should be cautious and do our best to avoid unplanned discontinuation of DAPT.”
Implication
Supports shorter DAPT in low-risk patients with newer DES; leaves open need for confirmatory RCTs in broader groups.
Structured PICO
Does 3-month DAPT following E-ZES implantation provide noninferior outcomes compared to 12-month DAPT following other DES implantation in patients with coronary artery stenosis?
P
Population
2,117 patients with coronary artery stenosis
I
Intervention
3-month dual antiplatelet therapy (DAPT) following Endeavor zotarolimus-eluting stent (E-ZES) implantation
C
Comparator
12-month dual antiplatelet therapy (DAPT) following other drug-eluting stent (DES) implantation (standard therapy)
O
Outcome
Composite endpoint of cardiovascular death, myocardial infarction, stent thrombosis, target vessel revascularization, or bleeding at 1 yearcomposite
A 3-month DAPT strategy following E-ZES implantation is noninferior to standard 12-month DAPT following other DES implantation for ischemic and bleeding outcomes at 1 year.
Cite This Study
Kim et al. (2012) studied this question.