How long should high-risk patients undergoing PCI receive DAPT?

One-month treatment with dual antiplatelet therapy (DAPT) results in similar ischaemic outcomes and lower bleeding risk compared with 3 months of DAPT in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI), a study has shown.

The XIENCE Short DAPT programme consisted of three prospective, multicentre, single-arm studies of HBR patients treated with a short DAPT course, followed by aspirin monotherapy after PCI with a cobalt-chromium everolimus-eluting stent.

Using propensity score stratification, the current exploratory analysis compared patients who received 1-month DAPT (XIENCE 28 USA and 28 Global) with those on 3-month DAPT (XIENCE 90). The authors assessed ischaemic and bleeding outcomes between 1 month and 12 months following index PCI.

Overall, 3,652 patients were enrolled; 1,392 patients after 1-month DAPT and 1,972 after 3-month DAPT met the eligibility criteria for analyses.

The primary endpoint of all-cause mortality or myocardial infarction was comparable between the two treatment groups (7.3 percent vs 7.5 percent; difference, –0.2 percent, 95 percent confidence interval [CI], –2.2 to 1.7; p=0.41).

The key secondary endpoint of Bleeding Academic Research Consortium (BARC) type 2–5 bleeding was lower with 1-month DAPT than 3-month DAPT (7.6 percent vs 10.0 percent; difference, –2.5 percent, 95 percent CI, –4.6 to –0.3; p=0.012).

Finally, major BARC type 3–5 bleeding did not differ significantly at 12 months (3.6 percent vs 4.7 percent; difference, –1.1 percent, 95 percent CI, –2.6 to 0.4; p=0.082), but was lower with 1-month DAPT at 90 days (1.0 percent vs 2.1 percent; p=0.015).