Clopidogrel Monotherapy After 1-Month DAPT in Patients With High Bleeding Risk or Complex PCI.

Background

High bleeding risk (HBR) and complex percutaneous coronary intervention (PCI) are major determinants for dual antiplatelet therapy (DAPT) duration.

Objectives

The aim of this study was to evaluate the effects of HBR and complex PCI on short vs standard DAPT.

Methods

Subgroup analyses were conducted on the basis of Academic Research Consortium-defined HBR and complex PCI in the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Verulam's-Eluting Cobalt-Chromium Stent-2) Total Cohort, which randomly compared clopidogrel monotherapy after 1-month DAPT with 12-month DAPT with aspirin and clopidogrel after PCI. The primary endpoint was the composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) or bleeding (Thrombolysis In Myocardial Infarction [TIMI] major or minor) endpoints at 1 year.

Results

Regardless of HBR (n = 1,893 [31.6%]) and complex PCI (n = 999 [16.7%]), the risk of 1-month DAPT relative to 12-month DAPT was not significant for the primary endpoint (HBR, 5.01% vs 5.14%; non-HBR, 1.90% vs 2.02%;

Conclusions

The effects of 1-month DAPT relative to 12-month DAPT were consistent regardless of HBR and complex PCI. The absolute benefit of 1-month DAPT over 12-month DAPT in reducing major bleeding was numerically greater in patients with HBR than in those without HBR. Complex PCI might not be an appropriate determinant for DAPT durations after PCI. (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 [STOPDAPT-2], NCT02619760; Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 for the Patients With ACS [STOPDAPT-2 ACS], NCT03462498).

Informations de copyright

© 2023 The Authors.

Déclaration de conflit d'intérêts

This work (STOPDAPT-2 and STOPDAPT-2 ACS) was supported by Abbott Vascular Japan. The study sponsor is not involved in the implementation of the study, data collection, event fixation, and statistical analysis. However, approval of the study sponsor should be obtained for presentation in scientific meetings and submission of papers. Dr Hirotoshi Watanabe has received honoraria from Abbott Medical, Abiomed, Bayer, Bristol Myers Squibb, Daiichi Sankyo, Kowa, Pfizer, and Otsuka; and has received support for attending meetings from Abbott Medical. Dr Morimoto has received lecture fees from Bristol Myers Squibb, Daiichi Sankyo, Japan Lifeline, Kowa, Kyocera, Novartis, and Toray; has received manuscript fees from Bristol Myers Squibb and Kowa; and has participated on an advisory board for Sanofi. Dr Natsuaki has received honoraria from Abbott Medical. Dr Suzuki has received honoraria from Abbott Medical. Dr Tanabe has received honoraria from Abbott Medical, AstraZeneca, Boston Scientific, Daiichi Sankyo, Japan Lifeline, and Terumo; and has participated on an advisory board for Abbott. Dr Morino has received honoraria from Abbott Medical. Dr Kadota has received honoraria from Abbott Medical. Dr Furukawa has received honoraria from Bayer, Daiichi Sankyo, and Sanofi. Dr Nakagawa has received a research grant from Abbott Medical; has received honoraria from Abbott Medical and Daiichi Sankyo; and has participated on an advisory board for Abbott. Dr Kimura has received research grants from Abbott Medical and Boston Scientific; has received honoraria from Abbott Medical, Boston Scientific, Daiichi Sankyo, Sanofi, and Terumo; and has participated on advisory boards for Abbott Medical, Boston Scientific, and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.