Abbreviated DAPT found safe in high-risk patients undergoing PCI

In patients at high risk of bleeding who are undergoing percutaneous coronary intervention (PCI), abbreviated dual antiplatelet therapy (DAPT) durations, especially 3-month regimens, reduces bleeding events without increasing the risk of fatal or nonfatal ischaemic cardiovascular or cerebrovascular events when compared with standard DAPT durations, according to a meta-analysis.

Researchers searched multiple online databases for randomized clinical trials (RCTs) in which abbreviated (1- to 3-month) and standard (6- to 12-month) DAPT durations were compared in PCI patients at high risk of bleeding without an indication for oral anticoagulation.

The coprimary safety and efficacy endpoints were major or clinically relevant nonmajor bleeding (MCRB) and major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial infarction, or stroke.

Pooled data from 14 RCTs involving 11,398 patients (mean age 74.7 years, 39.1 percent female) showed that compared with standard DAPT, abbreviated DAPT was associated with a more than 20-percent reduction in the risks of MCRB (risk ratio [RR], 0.71, 95 percent confidence interval [CI], 0.55–0.92; p=0.009) and major bleeding (RR, 0.76, 95 percent CI, 0.59–0.99; p=0.04).

The risk of MACE did not significantly differ between the abbreviated and standard DAPT durations (RR, 0.97, 95 percent CI, 0.81–1.16; p=0.76). However, data from one RCT that compared abbreviated DAPT durations showed an increased risk of MACE with 1- vs 3-month DAPT, although the network estimate was not significant (RR, 1.28, 95 percent CI, 0.96–1.72).