High Risk of Bleeding after PCI: More Evidence for Short DAPT

Dual antiaggregation therapy (DAPT) with ASA and P2Y12 during 6 to 12 months is the indicated strategy after DES stenting to reduce ischemic events. However, in patients with elevated risk of bleeding (HBR) guideline and expert recommendations is 1-6 months, since there is plenty of evidence in favor, except for a randomized study, the MASTER DAPT, and different analysis or registries. 

This meta-analysis of 932 studies selected three randomized controlled trials with 8895 patients and 3 studies with 7953 matched with propensity score, all presenting HBR. 8422 of these patients received DAPT from 6 to 12 months (L –DAPT) and 8426 DAPT for 1 to 3 months (S-DAPT).

Patients receiving S-DAPT showed a lower rate of bleeding compared against L-DAPT patients, 2.6% vs. 3.8% [OR 0.68; 95% CI 0.51-0.89 absolute risk difference -1.2%]. There were no differences in MACE, or death, stroke, or MI. The presence of stent thrombosis was also similar, even though numerically superior to that of S-DAPT patients, with no statistical significance. 

Conclusion 

Among patients with HBR receiving contemporary drug eluting, S-DAPT reduced bleeding with no increase in risk of death, compared against L-DAPT. Further research is needed to assess late thrombosis after 1-to-3-month DAPT among patients with high ischemic and bleeding risk, to define the SAPT of choice afterwards.

Original Title: Dual antiplatelet therapy duration after percutaneous coronary intervention using drug eluting stents in high bleeding risk patients: A systematic review and meta-analysis

Reference: Aakash Garg, et al. Am Heart J 2022;250:1–10.

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