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Pooled analysis of bleeding, major adverse cardiovascular events, and all‐cause mortality in clinical trials of time‐constrained dual‐antiplatelet therapy after percutaneous coronary intervention

Journal of the American Heart Association Aug 21, 2020

McClure JD, et al. - Dual antiplatelet therapy (DAPT) had net clinical benefits reflecting the paradoxical effects of an increased risk of bleeding and a reduced risk of major adverse cardiovascular events. In 5 multicenter trials including GLOBAL LEADERS, STOPDAPT2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus‐Eluting Cobalt‐Chromium Stent‐2), SMART‐CHOICE, TWILIGHT (Ticagrelor With Aspirin or Alone in High‐Risk Patients After Coronary Intervention), and TICO (Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus Stent for Acute Coronary Syndrome), a time‐constrained approach to DAPT has been recently examined. Via performing a pooled analysis of these trials, researchers sought to determine the overall correlations between time‐constrained P2Y12 inhibitor monotherapy (aspirin‐free regimen) for bleeding events, major adverse cardiovascular events, and all‐cause mortality as compared with standard care with DAPT for at least 12 months postpercutaneous coronary intervention. A substantial reduction in the risk of major and fatal bleeding was observed in correlation with P2Y12 inhibitor monotherapy from 1 to 3 months compared with DAPT for 12 months postpercutaneous coronary intervention. In addition, P2Y12 inhibitor monotherapy from 1 to 3 months confers potentially protective effects, for major adverse cardiovascular events and all‐cause mortality. Accounting patient safety, the findings support a strategy of DAPT for 1 to 3 months followed by aspirin‐free P2Y12 inhibitor monotherapy.

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