Dr. Marco Valgimigli is a senior interventional cardiologist at the Inselspital Universitätsspital Bern and an associate professor of cardiology.
Dr. Valgimigli talks about Dual Antiplatelet Therapy after PCI in Patients with High Bleeding Risks.
Link to Abstract-
The optimal length of dual antiplatelet medication after the installation of a drug-eluting coronary stent in patients at high risk of bleeding is unknown.
One month after receiving a biodegradable polymer sirolimus-eluting coronary stent, patients with a high risk of bleeding were randomly allocated to terminate dual antiplatelet medication immediately (abbreviated therapy) or continue it for at least two months (standard therapy). Net adverse clinical events (a composite of death from any cause, myocardial infarction, stroke, or major bleeding), major adverse cardiac or cerebral events (a composite of death from any cause, myocardial infarction, stroke, or major bleeding), and major or clinically relevant nonmajor bleeding were the three ranked primary outcomes; cumulative incidences were assessed at 335 days. In the per-protocol population, the first two outcomes were evaluated for noninferiority, while the third outcome was evaluated for superiority in the intention-to-treat population.
Net adverse clinical events occurred in 165 patients (7.5%) in the abbreviated-therapy group and 172 (7.7%) in the standard-therapy group (difference, 0.23 percentage points; 95 percent confidence interval [CI], 1.80 to 1.33; P0.001 for noninferiority). A serious adverse cardiac or cerebral event occurred in 133 patients (6.1%) in the abbreviated-therapy group and 132 patients (5.9%) in the standard-therapy group (difference, 0.11 percentage points; 95 percent CI, 1.29 to 1.51; P=0.001 for noninferiority). Major or clinically relevant nonmajor bleeding occurred in 148 patients (6.5%) in the abbreviated-therapy group and 211 (9.4%) in the standard-therapy group in the intention-to-treat population (difference, 2.82%; 95 percent CI, 4.40 to 1.24; P0.001 for superiority).
In terms of the occurrence of net adverse clinical events and major adverse cardiac or cerebral events, one month of dual antiplatelet therapy was noninferior to continuing therapy for at least two additional months; abbreviated therapy also resulted in a lower incidence of major or clinically relevant nonmajor bleeding.