Is it Possible to Reduce DAPT Time in Diabetic Patients?

Short-duration dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with DES is growing steadily, especially for chronic coronary syndromes. There is also some evidence regarding its use in acute coronary syndrome.

DAPT en los diabéticos

However, diabetes is a well-known risk factor for both restenosis and thrombosis, since it involves more complex and longer lesions in vessels that are generally smaller in diameter.

Researchers conducted a subanalysis of randomized studies STOPDAPT-2 and STOP-DAPT-2ACS, comparing DAPT for 30 days with ASA 81 mg and clopidogrel, and then clopidogrel monotherapy vs. DAPT for 12 months.

This subanalysis included 5997 patients. Of these, 2030 had diabetes (33.8%) and 3967 did not. 

The primary endpoint (PEP) was a composite of cardiovascular events and bleeding. The former comprised cardiovascular death, infarction, stroke, and definite stent thrombosis. The second included major and minor bleeding according to TIMI criteria.

As regards diabetic patients, 60.9% received pharmacological treatment and 14.1%, insulin.

Read also: Can We Use DAPT for 3 Months in Acute Coronary Syndrome?

After 12 months of follow-up, there were no differences neither in the PEP (3.58% for 1-month DAPT vs. 4.12% for 12-month DAPT; hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.56-1.37; p = 0.55) nor for cardiovascular death (3.02 vs. 3.5; p = 0.7). However, those who received DAPT for 30 days experienced less bleeding compared with those who received it for 12 months (0.30% vs. 1.50% [HR: 0.20; 95% CI: 0.06 to 0.68; p = 0.01).

Conclusion

Clopidogrel as monotherapy after 1 month with DAPT, compared with 12 months of DAPT, reduced major bleeding without an increase in cardiovascular events independent of diabetes. These findings should be considered hypothesis-generating, especially in patients with acute coronary syndromes, as the results from the STOPDAPT -2 ACS Study are inconclusive.

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
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, et al. J Am Coll Cardiol Intv 2023;16:19–31.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

QFR vs. FFR: Is Coronary Revascularization Deferral Safe? Results from a FAVOR III Sub-Analysis

In cases of intermediate coronary lesions, functional assessment is recommended to aid the decision-making process regarding revascularization. There are several tools currently used to...

FRANCE TAVI Registry: Coronary Adverse Events After TAVI

Between 30% and 70% of patients undergoing transcatheter aortic valve implantation (TAVI) have coronary artery disease (CAD). However, the prognostic impact of CAD in...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Prospective Analysis of the Feasibility of the PASCAL System for Transcatheter Mitral Repair: OneForAll Registry

Courtesy of Dr. Juan Manuel Pérez. Mitral transcatheter edge-to-edge repair (M-TEER) is an effective option for patients with severe mitral regurgitation who are at high...

Left Bundle Branch Block after TAVR: What Is Its Impact?

Courtesy of Dr. Juan Manuel Pérez. Left bundle branch block (LBBB) is a common complication following transcatheter aortic valve replacement (TAVR), which can be either...