Shorter Duration of DAPT Safe After Stent Placement

A shorter one-month duration of treatment with dual-antiplatelet therapy (DAPT) followed by aspirin monotherapy was as effective as a six- to 12-month duration of treatment at preventing major cardiovascular (CV) outcomes and death in patients who just received a drug-eluting stent (DES), according to results of a study presented as part of a news briefing at the American Heart Association Scientific Sessions 2020.

“DAPT for one month followed by aspirin monotherapy was not inferior to 6 to 12 months of DAPT in terms of one-year outcomes among patients receiving DES,” said Myeong-Ki Hong, MD, PhD, of Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. “The clinical implication is that discontinuing a P2Y12 inhibitor, rather than aspirin, in daily clinical practice may be associated with better patient compliance, lower costs, a lower risk of bleeding, and overall superior convenience and level of comfort for both patients and physicians.”

According to Dr. Hong, after DES implantation, DAPT with aspirin and a P2Y12 inhibitor is required to prevent ischemic events, such as stent thrombosis or myocardial infarction.

“However, as we know, prolonged dual antiplatelet therapy is costly and increases the likelihood of bleeding and patient noncompliance; thus, efforts have been made to shorten the duration of dual antiplatelet therapy,” Dr. Hong added.

The current recommendation is that duration of DAPT should be six to 12 months after stent placement. According to Dr. Hong, it is necessary to determine the appropriate minimal duration of DAPT followed by aspirin monotherapy.

Dr. Hong and colleagues conducted a non-inferiority trial to look at one-month DAPT followed by aspirin (n=1,507) compared with a six- to 12-month duration (n=1,513). The composite endpoint was cardiovascular events or major bleeding at one-year follow-up.

The primary endpoint was similar between the two arms, occurring in 5.9% of patients assigned the shorter duration compared with 6.5% of patients assigned the longer duration. There was an absolute difference of -0.7% (P<0.001 for non-inferiority).

There were no significant differences in clinical outcomes between the two arms at one year. Stent thrombosis occurred in 0.7% of the one-month group and 0.8% of the six- to 12-month group. Major bleeding occurred in 1.7% of the one month group and 2.5% in the 6-12 month group.