Very short duration of DAPT well tolerated and feasible after coronary interventions

The study found that VSDAPT (> 3 months duration) significantly reduced the risk of NACE (net adverse clinical events) and major bleeding by 17% and 29% without affecting ischemic events (MI, stroke, MACE, stroke, revascularization and stent thrombosis) and mortality.

According to the authors, the systematic review and meta-analysis are the first to include more than 40,000 patients undergoing PCI with a drug-eluting stent in the era of VSDAPT.

DAPT (Dual antiplatelet treatment) is the standard of care after PCI, but it increases bleeding risk and leads to adverse or event data events. Selecting a P2Y12 inhibitor and DAPT duration can significantly impact the balance between ischemia and hemorrhage.

Current guidelines recommend DAPT after PCI with drug-eluting stents for 12 and 6 months for acute (ACS) and chronic coronary syndrome (CCS), respectively; this period could be reduced for 1-3 months for patients with high bleeding risk. However, based on individualized management, the DAPT duration could be prolonged per the patient's technical, anatomical, or clinical characteristics. Against this background, various studies have examined whether the VSDAPT strategy could be safe and feasible after newer-generation DES implantation but have yet to yield conflicting results. Some studies have shown benefits with short DAPT, while others raised concerns for increased risk of thrombotic complications.

To clarify the above ambiguity, Grigorios Tsigka from the University Hospital of Patras in Patras, Greece, and colleagues compared the very short versus > 3 months' duration of DAPT in patients undergoing PCI with DES, focusing on ischemic and bleeding events in a systematic review and meta-analysis.

For this purpose, the researchers screened three significant databases for eligible randomized controlled trials (RCTs). The incidence of NACE as defined per trial (primary endpoint) was determined. Secondary endpoints included all-cause and cardiovascular mortality, MACE (major adverse cardiovascular events), stent thrombosis, stroke, myocardial infarction, major bleeding, and repeat revascularization.

Eight RCTs comprising 41,204 patients were included; 20,592 patients were allocated to VSDAPT, and the rest 20,612 patients were randomized to a more extended DAPT period.

The regimen of shorter duration significantly reduced NACE (odds ratio [OR] 0.83) and major bleeding (OR 0.71) without affecting ischemic events (stroke, revascularization, myocardial infarction, and stent thrombosis) or mortality.

"Our meta-analysis supports very short-term DAPT, but the P2Y12 inhibitor and the duration selection should be tailored to individual benefit-risk profiles," the researchers concluded.

Reference:

Tsigkas, G., Apostolos, A., Trigka, A. et al. Very Short Versus Longer Dual Antiplatelet Treatment After Coronary Interventions: A Systematic Review and Meta-analysis. Am J Cardiovasc Drugs (2022). https://doi.org/10.1007/s40256-022-00559-0