Optimal Antiplatelet Therapy After PCI in High-Bleeding-Risk Patients

A large, randomized trial suggests that 1 month of dual antiplatelet therapy provides similar clinical outcomes and a lower bleeding risk than 3- to 6-month regimens for this challenging-to-treat patient subset.

Several recent randomized trials suggest that abbreviated dual antiplatelet therapy (DAPT; aspirin plus a platelet P2Y₁₂ receptor antagonist) can reduce the risk for bleeding without increasing the risk for thrombotic events after percutaneous coronary intervention (PCI) with stent placement. However, these studies have not focused specifically on high-bleeding-risk patients, many of whom are also at high risk for thrombotic and ischemic complications.

To address this issue, in an industry-sponsored, unblinded, investigator-initiated MASTER-DAPT trial (NCT03023020), investigators randomized 4579 patients (mean age, 76 years) with high bleeding risk who had received a biodegradable-polymer sirolimus-eluting stent to an abbreviated DAPT regime…

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)