1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI

• Published in: JACC. Cardiovascular interventions 2023-10, Vol.16 (20), p.2498-2510
• Main Authors: Valgimigli, Marco, Spirito, Alessandro, Sartori, Samantha, Angiolillo, Dominick J., Vranckx, Pascal, de la Torre Hernandez, Jose M., Krucoff, Mitchell W., Bangalore, Sripal, Bhatt, Deepak L., Campo, Gianluca, Cao, Davide, Chehab, Bassem M., Choi, James W., Feng, Yihan, Ge, Junbo, Hermiller, James, Kunadian, Vijay, Lupo, Sydney, Makkar, Raj R., Maksoud, Aziz, Neumann, Franz-Josef, Picon, Hector, Saito, Shigeru, Sardella, Gennaro, Thiele, Holger, Toelg, Ralph, Varenne, Olivier, Vogel, Birgit, Zhou, Yujie, Windecker, Stephan, Mehran, Roxana
• Format: Article
• Language: English
• Subjects: dual antiplatelet therapy; everolimus-eluting stent(s); high bleeding risk; oral anticoagulant therapy; percutaneous coronary intervention
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2023.08.014

The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients on long-term oral anticoagulation (OAC) therapy is still uncertain. The aim of this analysis was to assess the effects of 1- vs 3-month DAPT in patients with and those without concomitant OAC included in the XIENCE Short DAPT program. The XIENCE Short DAPT program enrolled patients with high bleeding risk who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. DAPT was discontinued at 1 or 3 months in patients free from ischemic events and adherent to treatment. The effect of 1- vs 3-month DAPT was compared in patients with and those without OAC using propensity score stratification. The primary endpoint was all-cause death or any myocardial infarction (MI). The key secondary endpoint was Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after index PCI. Among 3,364 event-free patients, 1,462 (43%) were on OAC. Among OAC patients, the risk for death or MI was similar between 1- and 3-month DAPT (7.4% vs 8.8%; adjusted HR: 0.74; 95% CI: 0.49-1.11; P = 0.139), whereas BARC types 2 to 5 bleeding was lower with 1-month DAPT (adjusted HR: 0.71; 95% CI: 0.51-0.99; P = 0.046). These effects were consistent in patients with and those without OAC (P for interaction = NS). Between 1 and 12 months after PCI, 1-month compared with 3-month DAPT was associated with similar rates of all-cause death or MI and a reduced rate of BARC types 2 to 5 bleeding, irrespective of OAC treatment. [Display omitted]