Short Therapy and Monotherapy, Plenty of Evidence

A short dual antiplatelet therapy (DAPT) of 1 to 3 months followed by P2Y12 inhibitor monotherapy after second generation drug eluting stent (DES) implantation is safer and as effective as the traditional scheme.

The idea is clear, but why hasn’t aspirin monotherapy been tested as follow up? Is aspirin old fashioned? Are there physiopathological reasons to this choice or is it a matter of cost? These questions are still relevant and require research.

This meta-analysis included 5 randomized studies with over 30,000 patients explores the hypothesis of short DAPT (≤ 3 months) followed by P2Y12 inhibitor vs. 12-month DAPT after 2nd gen DES.

Primary end point were major bleeding and stent thrombosis at one year after randomization.

Major bleeding resulted significantly lower in patients receiving a short scheme (HR 0.63, CI 95% 0.45 to 0.86) followed by P2Y12 monotherapy vs 12-month DAPT.

Improved safety with the short scheme did not pay any cost in terms of stent thrombosis. Thrombosis resulted similar for both schemes (HR 1.19, CI 95% 0.86 to 1.65).


Read also: Diastolic Pressure Could Play a Dirty Trick on Patients Treated for Hypertension.


All secondary end points (all cause death, myocardial infarction or stroke) resulted similar between antiaggregation strategies).

Sensitivity analysis showed consistent results when comparing different randomized studies or patient subgroups. 

Conclusion

One to three month DAPT followed by P2Y12 inhibitor was associated to less major bleeding and similar stent thrombosis rate, death, MI or stroke, compared against the traditional 12 month DAPT scheme.

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Original Title: Short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. prolonged dual antiplatelet therapy after percutaneous coronary intervention with second-generation drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials.

Reference: Daniele Giacoppo et al. European Heart Journal (2021) 42, 308–319 doi:10.1093/eurheartj/ehaa739.


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