Currently, many randomized studies have suggested that short-term dual antiplatelet therapy (DAPT) followed by monotherapy reduces bleeding without increasing major cardiovascular events after percutaneous coronary intervention (PCI). A meta-analysis of six randomized studies has shown this benefit using ticagrelor monotherapy after short DAPT. However, there is no data on the results of clopidogrel monotherapy.
Researchers conducted an analysis of two multicenter prospective studies from Japan, STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent–2) and STOPDAPT-2 ACS (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent–2 for the Patients With ACS).
The aim of this sub-study was to evaluate the short-term safety and efficacy of clopidogrel monotherapy after DAPT in diabetic patients who underwent PCI.
The primary endpoint (PEP) was a composite of cardiovascular death, acute myocardial infarction, defined stent thrombosis, stroke, and major or minor TIMI bleeding at 1 year. The secondary endpoint (SEP) were the PEP items.
Out of all 5997 patients, 33% had diabetes. These patients were randomized to one month of DAPT (n = 1018) or 12 months of DAPT (n = 1012). Mean patient age was 68 years old, and most subjects were male. Themost frequent clinical presentation was ST-segment elevation acute coronary syndrome.
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The most treated artery was the anterior descending artery. It should be highlighted that, in this study, intravascular imaging was used in 97% of cases, and intravascular ultrasound (IVUS) was the most frequent imaging tool. Clopidogrel was the main antithrombotic treatment, followed by prasugrel.
Results showed that the incidence of the PEP at one year was higher in diabetic patients compared with non-diabetic patients (p = 0.004). When analyzing diabetic patients, there were no differences regarding the PEP between the 1-month DAPT vs. the 12-month DAPT arms (p = 0.55). The same was noted for non-diabetic patients (p = 0.97).
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In terms of bleeding, diabetic patients with 12-month DAPT had significantly more major events than those in the one-month DAPT arm. In non-diabetic patients, there was a non-statistically significant difference between groups.
Conclusion
Clopidogrel monotherapy after 1-month DAPT, compared with 12-month DAPT, showed a decrease in major bleeding without increasing cardiovascular events in diabetic patients.
Dr. Andrés Rodríguez.
Member of the editorial board of SOLACI.org.
Original Title: Clopidogrel Monotherapy After 1-Month Dual Antiplatelet Therapy in Patients With Diabetes Undergoing Percutaneous Coronary Intervention.
Reference: Ko Yamamoto, MD et al J Am Coll Cardiol Intv 2022.
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