Key result
Antiplatelet monotherapy after 1-month DAPT reduces bleeding without increasing ischemic events in HBR patients.
Why the study?
There is growing debate about which antiplatelet monotherapy is optimal after discontinuation of shortened DAPT in high-bleeding risk patients undergoing PCI with drug-eluting stents.
Does antiplatelet monotherapy after shortened DAPT reduce bleeding risk compared to conventional DAPT in high-bleeding risk patients undergoing PCI with drug-eluting stents?
Does antiplatelet monotherapy after shortened DAPT reduce bleeding risk compared to conventional DAPT in high-bleeding risk patients undergoing PCI with drug-eluting stents?
Shortening DAPT to 1 month followed by antiplatelet monotherapy is a safe and beneficial strategy for high-bleeding risk patients undergoing PCI.
Supports de-escalation to monotherapy after 1-month DAPT in high-bleeding risk PCI; leaves open optimal P2Y12 agent selection.
Dual antiplatelet therapy (DAPT) is the recommended treatment after percutaneous coronary intervention (PCI). The introduction into clinical practice of new drug-eluting stents (DESs) with significantly improved safety profiles has made it possible to shorten the DAPT. Randomized studies have established the superiority of DES over bare metal stents in high-bleeding risk (HBR) patients treated with antiplatelet monotherapy after 1 month of DAPT from PCI. This regimen has been adopted in randomized trials comparing different DES in patients with HBR. Furthermore, antiplatelet monotherapy after 1 month of DAPT from PCI has been shown to reduce bleeding risk without increasing ischaemic events compared with a conventional DAPT regimen (3–12 months) in a recent randomized study that included HBR patients treated with DES. Parallel to the trend of shortening DAPT, there is growing debate about which antiplatelet monotherapy is optimal after discontinuation of DAPT, with some recent studies exploring the paradigm shift from aspirin monotherapy to P2Y12 inhibitor monotherapy. Finally, future studies are underway to evaluate the clinical effect of monotherapy with ticagrelor or prasugrel directly after implantation of DES thus eliminating DAPT.
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Piera Capranzano (2022) conducted a review in High-bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Antiplatelet monotherapy (after shortened DAPT) vs. Conventional dual antiplatelet therapy (DAPT) regimen (3-12 months) was evaluated. Antiplatelet monotherapy after 1 month of DAPT reduces bleeding risk without increasing ischemic events compared with a conventional DAPT regimen in high-bleeding risk patients treated with drug-eluting stents.
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