No significant difference of mortality and incident MI between post PI DAPT duration of one month and 3 months

Dual antiplatelet therapy (DAPT) is the combination of aspirin and one ADP-receptor blocker (clopidogrel, prasugrel, or ticagrelor). The duration of DAPT is a matter of discussion.

A new study in Journal of American College of Cardiology states that DAPT for 1 vs. 3 months after Percutaneous coronary Intervention (PCI) was associated with a similar adjusted risk of death or Myocardial Infarction (MI) and a consistent reduction of Bleeding Academic Research Consortium (BARC) type bleeding in both oral anticoagulation (OAC) and no-OAC groups.

The researchers in the current study used XIENCE Short DAPT program, which enrolled high bleeding risk (HBR) patients who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. This analysis was designed to compare the effect of 1- versus 3-month DAPT on clinical outcomes separately in patients with and without long-term OAC.

DAPT was discontinued at 1 or at 3 months in patients free from ischemic events and adherent to treatment. The effect of 1- versus 3-month DAPT was compared in patients with and without OAC using propensity score stratification. The primary endpoint was all-cause death or any myocardial infarction (MI). The key secondary endpoint was BARC 2-5 bleeding. Outcomes were assessed from 1 to 12 months after index PCI.

The key findings of the study

• Total of 3,364 event-free patients, 1,462 (43%) were on OAC. Among OAC patients, the risk of death or MI was similar between 1- and 3-month DAPT (7.4% vs. 8.8%).

• BARC 2-5 bleeding was lower with 1-month DAPT. These effects were consistent in patients with or without OAC.

Researchers added that these data suggest that 1-month DAPT followed by aspirin monotherapy might be a suitable option in high bleeding risk (HBR) patients at low ischemic risk, especially if on long-term OAC treatment to maximize bleeding protection without trade-off of ischemic events.

Additional randomized studies are indicated to assess the most appropriate timing of early DAPT discontinuation after PCI and which agent (aspirin vs. P2Y12 inhibitor) should be continued in HBR patients taking OAC.

In conclusion they stated that “Between 1 and 12 months after PCI, 1- compared with 3-month DAPT was associated with a similar rate of all-cause death or MI and a reduced rate of BARC 2-5 bleeding, irrespective of OAC treatment.”

Reference: 1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI. JACC Cardiovasc Interv 2023;Oct 4.