Evaluating the effectiveness and safety of a shorter dual antiplatelet therapy duration after coronary stenting in patients with acute or recent heart attack at high bleeding risk.

This study evaluated the effectiveness and safety of a shorter dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in patients with acute or recent myocardial infarction (MI; heart attack) at high bleeding risk. The data showed that a shorter DAPT duration (1 month) significantly reduced the risk of bleeding compared with a long DAPT duration (minimum of 3 months) with similar risks of death or heart attacks in these patients.

Coronary artery disease (CAD) is a condition in which the blood vessels in the heart become blocked. CAD can lead to acute myocardial infarction (MI), also known as a heart attack. PCI (angioplasty) is a minimally-invasive surgical procedure to improve blood flow. During PCI the blockage in the artery is removed. In some cases, a stent may be inserted to keep a blood vessel open. Drug-eluting stents (DES) also release medication into the body. These drugs prevent cells from gathering inside the stent and blocking it again.

One risk with PCI using DES is that blood clots can form on the stent and cause a blockage. Platelets are cells in the blood that cause clotting. Dual antiplatelet therapy (DAPT) is used to reduce this risk. DAPT reduces the risk of clotting and further blockages after PCI. Acetylsalicylic acid (Aspirin) and ticagrelor (Brilique) are antiplatelet (APT) medications commonly used in DAPT. However, DAPT increases the risk of bleeding in patients with CAD. The optimal DAPT duration after PCI using DES in patients with acute or recent MI at high bleeding risk is still unknown.

This study involved a total of 4579 patients at high bleeding risk. Patients were previously treated with PCI using DES. Patients were randomly assigned into two groups. Group 1 included 2295 patients who received DAPT for 1 month and then single APT for 11 months or 5 months of oral anticoagulant (medications that prevent blood clotting). Group 2 included 2284 patients who received DAPT for a minimum of 3 months. Patients were followed up for an average of 335 days.

Short DAPT duration reduced the risk of major bleeding by 35% compared to long DAPT duration in patients with acute or recent MI. Short DAPT duration reduced the risk of major bleeding by 29% compared to long DAPT duration in patients without acute or recent MI.

There was no significant difference in heart attacks, stroke rates, death events, or serious side effects between the two groups.

This study concluded that a short DAPT duration (1 month) significantly reduced the risk of bleeding compared with a long DAPT duration (minimum of 3 months) with similar risks of death or heart attacks in patients with acute or recent MI at high bleeding risk.

The patients knew which treatment they were getting, which might affect the conclusions. This study only included patients who were at a high bleeding risk and those who received biodegradable polymer DES.