Summary of “Optimal DAPT Duration in Patients With High and Low Bleeding Risk?”
Summary of “Optimal DAPT Duration in Patients With High and Low Bleeding Risk?”
1. Study Overview: The study examined the optimal duration of dual antiplatelet therapy (DAPT) after stent implantation in patients with high bleeding risk (HBR) and low bleeding risk (LBR). It was presented at ACC.25 in Chicago.
2. Patient Enrollment: Nearly 4,900 patients from South Korea were enrolled:
• 1,598 patients with HBR (average age 73.8 years, 33.5% women)
• 3,299 patients with LBR (average age 63.2 years, 20.9% women)
3. Study Design:
• HBR group: randomized to 1-month or 3-month DAPT.
• LBR group: randomized to 3-month or 12-month DAPT.
• Clinicians had discretion over P2Y12 inhibitor use during or after DAPT.
4. Primary Endpoints:
• Net adverse clinical events (NACE): including death, MI, stent thrombosis, stroke, or major bleeding.
• Major adverse cardiac or cerebral events (MACCE): including cardiovascular disease, MI, stent thrombosis, or ischemic stroke.
• Any actionable bleeding at 12 months.
5. Results:
• HBR Group: 3-month DAPT reduced NACE and MACCE compared to 1-month (14.4% vs. 18.4%; 6.4% vs. 10.3%) without increasing bleeding risk (17.9% vs. 15.6%).
• LBR Group: Similar NACE and MACCE outcomes for 3-month vs. 12-month DAPT (4% vs. 5.7%; 2.5% vs. 2.8%). The 3-month regimen had less bleeding (9.2% vs. 13.7%).
6. Conclusion: Three-month DAPT is optimal for both HBR and LBR patients, with better or comparable outcomes and lower bleeding risks.
7. Study Limitation: The trial was conducted in South Korea with 80% of patients receiving clopidogrel, which may limit the generalizability of results to other regions where ticagrelor is more commonly used.
8. Future Follow-Up: The trial will continue for three years to observe long-term effects of DAPT duration.
It’s the first study to examine the question of the optimal DAPT duration in patients at both high and low risk of bleeding.
