Why the study?
The efficacy and safety of an abbreviated duration of dual antiplatelet therapy in patients with high bleeding risk undergoing percutaneous coronary intervention remain controversial.
Does shortened dual antiplatelet therapy (1, 3, or 6 months) reduce bleeding without increasing ischemic events in patients with high bleeding risk undergoing percutaneous coronary intervention?
Does shortened dual antiplatelet therapy (1, 3, or 6 months) reduce bleeding without increasing ischemic events in patients with high bleeding risk undergoing percutaneous coronary intervention?
In high bleeding risk patients undergoing PCI, 1- or 6-month DAPT appears safe regarding MACE, with 6-month DAPT reducing major bleeding, though 3-month DAPT may increase ischemic stroke risk.
Answers are grounded in this paper and cite their sources.
Supports tailored short DAPT in HBR-PCI now; confirms 1- and 6-month safety while leaving 3-month ischemic risk open.
BACKGROUND: The efficacy and safety of an abbreviated duration of dual antiplatelet therapy (DAPT) in patients with high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) (PCI-HBR patients) remain controversial. METHODS: The Cochrane Library, PubMed, EMBASE, and Ovid MEDLINE databases were searched. Studies that enrolled PCI-HBR patients as research subjects, compared different DAPT durations, and reported incidences of major adverse cardiac events (MACE) and net adverse clinical events (NACE) in PCI-HBR patients were obtained. The studies were stratified according to the DAPT duration (1, 3, and 6 months), and meta-analysis was subsequently performed. RESULTS: Nine studies (10 cohorts) were included in the meta-analysis. Compared with those who received DAPT for >1 month, PCI-HBR patients who received the 1-month DAPT regimen had comparable risks of NACE and MACE. Compared to those who received DAPT for >3 months, the risk of developing MACE in PCI-HBR patients who received the 3-month DAPT was not increased; however, the risk of ischemic stroke and stent thrombosis increased. Compared to those who received DAPT for >6 months, patients who received the 6-month DAPT had a reduction in the risk of major bleeding without an increase in NACE and MACE. CONCLUSIONS: Shortening the DAPT regimen to 1 or 6 months did not increase the risk of MACE, and the 6-month DAPT regimen reduced the risk of major bleeding. However, the 3-month DAPT regimen increased the risk of ischemic stroke. Thus, shortened DAPT reduced the risk of MACE and bleeding, with a small absolute increase in ischemic strokes.
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Zhang et al. (2022) studied this question.
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