What Is the Optimal Duration of DAPT After Stent Implantation?

Dual-antiplatelet therapy (DAPT) for 1 month is not inferior to 6 to 12 months of DAPT for cardiovascular events and major bleeding at 1 year, according to the results of a recent study presented at the 2020 American Heart Association’s Scientific Sessions.

To better understand the optimal duration for use of DAPT after implantation of contemporary drug-eluting stents (DES), the researchers of this study conducted a randomized trial to evaluate patients without high bleeding risk.

A total of 3020 patients were randomly assigned to receive either 1 month of DAPT followed by aspirin monotherapy after polymer-free drug-coasted stent (n = 1507), or 6 to 12 months of DAPT followed by aspirin monotherapy after contemporary DES implementation (n = 1513). All participants were considered for revascularization with DES and did not have a high bleeding risk. The trial was conducted from December 2015 to September 2019 and included 23 centers in Korea.

The 1-year follow-up period was completed by 98.3% (n = 2969) of the participants. The primary endpoint for the study was a 1-year composite of cardiac death, myocardial infarction, target-vessel revascularization, stroke, and major bleeding.

The results indicated that in the 1-month DAPT group, the primary endpoints occurred in 88 participants (5.9%), while in the 6- to 12-month DAPT group, the primary endpoints occurred in 98 participants (6.5%).

Furthermore, in the 1-month DAPT group, 26 participants (1.7%) had major bleeding, while in the 6- to 12-month DAPT, group 38 participants (2.5%) had major bleeding. Stent thrombosis occurred in 11 participants (0.7%) in the 1-month DAPT group. Of the 6- to 12-month DAPT group, stent thrombosis occurred in 12 participants (0.8%).

“Among the patients who underwent DES implantation not confined to [high bleeding risk], one-month DAPT followed by aspirin monotherapy was not inferior to 6-12 months DAPT in terms of composite endpoint of cardiovascular event and major bleeding at 1-year,” the researchers concluded.

—Leigh Precopio

Reference:

Hong MK, Hong SJ, Kim JS, et al. One month dual antiplatelet therapy followed by aspirin monotherapy after drug eluting stent implantation. Paper presented at: American Heart Association Scientific Sessions 2020; November 13-17, 2020; Virtual. https://www.abstractsonline.com/pp8/?#!/9144/presentation/40162