Key result
Stopping DAPT after BVS shows no significant overall scaffold thrombosis increase despite early peaking risk.
Why the study?
The impact of dual antiplatelet therapy termination on late and very late scaffold thrombosis in patients treated with the Absorb BVS was unclear.
Does termination of DAPT before 18 months increase the incidence of late and very late scaffold thrombosis in patients treated with Absorb BVS?
Cohort (n=685)
Yes
Does termination of DAPT before 18 months increase the incidence of late and very late scaffold thrombosis in patients treated with Absorb BVS?
Absolute Event Rate: 1.77% vs 0.26%
p-value: p=0.12
Termination of DAPT before 18 months in patients with Absorb BVS is associated with a potentially increased risk of late and very late scaffold thrombosis, particularly within the first month after cessation.
Early DAPT termination may heighten scaffold thrombosis risk after Absorb BVS; hypothesis-generating for optimal duration.
AIMS: The aim of this study was to investigate the impact of dual antiplatelet therapy (DAPT) termination on late and very late scaffold thrombosis (ScT) in patients treated with the Absorb bioresorbable vascular scaffold (BVS). METHODS AND RESULTS: Data from the registries of three centres were pooled (808 patients). To investigate the effect of DAPT termination on ScT after a minimum of six months, we selected a subgroup ("DAPT study cohort" with 685 patients) with known DAPT status >6 months and excluded the use of oral anticoagulants and early ScT. In this cohort, definite/probable ScT incidence for the period on DAPT was compared to ScT incidence after DAPT termination. ScT incidence was 0.83 ScT/100 py with 95% confidence interval (CI): 0.34-1.98. After DAPT termination, the incidence was higher (1.77/100 py; 95% CI: 0.66-4.72), compared to the incidence on DAPT (0.26/100 py, 95% CI: 0.04-1.86; p=0.12) and increased within the month after DAPT termination (6.57/100 py, 95% CI: 2.12-20.38; p=0.01). No very late ScT occurred in patients who continued on DAPT for a minimum of 18 months. CONCLUSIONS: The incidence of late and very late definite/probable ScT was acceptable. The incidence was low while on DAPT but potentially higher when DAPT was terminated before 18 months.
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Felix et al. (2017) conducted a cohort in Absorb bioresorbable vascular scaffold (BVS) implantation (n=685). DAPT termination vs. DAPT continuation was evaluated on Definite/probable scaffold thrombosis (ScT) (p=0.12). DAPT termination in Absorb BVS patients yielded a scaffold thrombosis incidence of 1.77/100 py vs 0.26/100 py on DAPT (p=0.12), peaking significantly in the first month (6.57/100 py; p=0.01).
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