Key result
Abbreviated DAPT reaches only ~23% of high bleeding risk patients in real-world practice.
Why the study?
Guidelines recommend abbreviated dual antiplatelet therapy for patients at high bleeding risk undergoing PCI, but real-world adherence to this guidance was unknown.
Are guidelines for abbreviated dual antiplatelet therapy followed in real-world patients with high bleeding risk undergoing percutaneous coronary intervention?
Cohort (n=115,992)
Yes
Are guidelines for abbreviated dual antiplatelet therapy followed in real-world patients with high bleeding risk undergoing percutaneous coronary intervention?
In real-world practice, less than one third of high bleeding risk patients receive guideline-recommended abbreviated DAPT after PCI, as physicians continue to weigh ischemic risk markers heavily.
Abbreviated DAPT remains underused despite rising adoption in high-bleeding-risk PCI; leaves open whether education or tools can close the guidelines-practice gap.
BACKGROUND: Dual antiplatelet therapy reduces ischaemic complications after percutaneous coronary intervention, but increases bleeding risk, especially in patients who are already at high bleeding risk. Current guidelines therefore recommend abbreviated dual antiplatelet therapy in this population. AIM: To evaluate the real-world use of abbreviated dual antiplatelet therapy (≤3 months) after percutaneous coronary intervention according to bleeding risk, using data from the nationwide FRANCE-PCI registry. METHODS: All consecutive patients undergoing percutaneous coronary intervention for either acute or chronic coronary syndrome between 2014 and 2023 across 56 hospitals, who were alive at 1 year, and in whom dual antiplatelet therapy duration was known, were included. High bleeding risk was defined as the presence of at least one of the following: age≥75 years; chronic oral anticoagulant therapy; previous stroke; or chronic kidney disease. RESULTS: Among 115,992 patients included, 41.4% met the criteria for high bleeding risk. Abbreviated dual antiplatelet therapy was prescribed in 23.1% of patients with a high bleeding risk versus 3.6% of patients without a high bleeding risk. Among patients with a high bleeding risk, factors independently associated with prolonged (>3 months) dual antiplatelet therapy use were: increasing age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.02-1.03); female sex (OR 1.18, 95% CI 1.11-1.25); diabetes mellitus (OR 1.15, 95% CI 1.08-1.22); previous stroke (OR 1.54, 95% CI 1.39-1.69); chronic kidney disease (OR 1.24, 95% CI 1.15-1.34); acute coronary syndrome (OR 1.52, 95% CI 1.44-1.61); and stent length≥60mm (OR 1.18, 95% CI 1.09-1.28). CONCLUSIONS: In real-word practice, less than one third of patients with a high bleeding risk received abbreviated dual antiplatelet therapy after percutaneous coronary intervention. The use of prolonged dual antiplatelet therapy remained driven by ischaemic risk markers, highlighting persistent uncertainty in bleeding risk/ischaemic risk trade-offs.
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Singh et al. (2026) conducted a cohort in Acute or chronic coronary syndrome requiring percutaneous coronary intervention (n=115,992). High bleeding risk vs. Without high bleeding risk was evaluated on Prescription of abbreviated dual antiplatelet therapy (≤3 months). High bleeding risk patients received abbreviated dual antiplatelet therapy in only 23.1% of cases, compared to 3.6% of patients without high bleeding risk.
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