Abbreviated Antiplatelet Therapy After Coronary Stenting in Patients With Myocardial Infarction at High Bleeding Risk
Key result
1-month DAPT reduces bleeding with similar NACE and MACCE versus nonabbreviated DAPT in HBR MI patients.
Why the study?
The optimal duration of antiplatelet therapy after coronary stenting in patients at high bleeding risk presenting with an acute coronary syndrome remains unclear.
Does abbreviated antiplatelet therapy reduce bleeding and maintain ischemic safety compared to nonabbreviated therapy in high bleeding risk patients with acute or recent myocardial infarction after coronary stenting?
Population
4,579 patients at HBR after coronary stenting and 1 month of DAPT
Comparison
Abbreviated APT vs nonabbreviated APT
Design
Randomized controlled trial
Follow-up
335 days after randomization
Authors
Discussion
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Overview
Supports 1-month DAPT in high-bleeding-risk MI patients post-stenting; extends randomized evidence for abbreviated therapy to reduce bleeding.
Key Points
- This study aims to determine the safety and efficacy of abbreviated antiplatelet therapy in high bleeding risk patients post-coronary stenting.
- Randomized trial with 4,579 patients at high bleeding risk stratified by recent myocardial infarction.
- Participants were assigned to abbreviated (1 month DAPT then single APT) or nonabbreviated (minimum 3 months DAPT) therapy.
- Coprimary outcomes included net adverse clinical outcomes and major adverse cardiac and cerebral events measured at 335 days.
- Abbreviated APT resulted in similar rates of net adverse clinical outcomes and major adverse cardiac and cerebral events compared to nonabbreviated APT.
- Abbreviated therapy reduced bleeding events significantly, enhancing safety in this high risk population.
Structured PICO
Does abbreviated antiplatelet therapy reduce bleeding and maintain ischemic safety compared to nonabbreviated therapy in high bleeding risk patients with acute or recent myocardial infarction after coronary stenting?
P
Population
4,579 patients at high bleeding risk (HBR) presenting with an acute or recent myocardial infarction, after coronary stenting and 1 month of dual antiplatelet therapy (DAPT).
I
Intervention
Abbreviated antiplatelet therapy (DAPT stopped after 1 month, followed by 11 months of single antiplatelet therapy, or 5 months in patients with oral anticoagulants).
C
Comparator
Nonabbreviated antiplatelet therapy (DAPT for a minimum of 3 months).
O
Outcome
Coprimary outcomes at 335 days after randomization: net adverse clinical outcomes events (NACE); major adverse cardiac and cerebral events (MACCE); and type 2, 3, or 5 Bleeding Academic Research Consortium (BARC) bleeding.composite
A 1-month DAPT strategy in high bleeding risk patients with acute or recent MI reduces bleeding without compromising ischemic outcomes compared to standard prolonged DAPT.
Cite This Study
Smits et al. (2022) studied this question. A 1-month dual antiplatelet therapy strategy in high bleeding risk patients with myocardial infarction resulted in similar NACE and MACCE rates and reduced bleeding versus nonabbreviated DAPT.