After Stenting, Long-Term DAPT Benefits Those at Low Bleeding Risk More

By Joe Elia

Edited by Jaye Elizabeth Hefner, MD

Long-term (12- to 24-month) dual antiplatelet therapy (DAPT) offers the greatest benefit in patients not at high risk for bleeding events, according to a study in the Journal of the American College of Cardiology.

Investigators studied results from eight randomized trials encompassing some 15,000 patients undergoing percutaneous coronary intervention (PCI) and receiving DAPT. The patients were characterized both by the complexity of the intervention (e.g., PCIs with 3 or more stents placed were "complex") and by the patients' risk for bleeding events (by PRECISE-DAPT score).

The researchers found complex PCIs to be associated with higher rates of subsequent ischemic events, but not bleeding events. Patients at high bleeding risk suffered high rates of both ischemic and bleeding events. Patients without high bleeding risk showed consistent benefit from long-term DAPT, whereas those at high risk did not show ischemic or mortality benefit, regardless of PCI complexity.

Framing their study as "hypothesis-generating," the authors conclude that bleeding risk, rather than ischemia risk, should be given greater consideration in decisions about the length of DAPT.