Despite advances in therapy, the choice and duration of antiplatelet therapy following percutaneous coronary intervention (PCI) remains an area of active debate. While it has been postulated that long-term dual antiplatelet therapy (DAPT) are associated with reduced rates of thrombotic events, these benefits have been \u00a0offset by increased bleeding risk.<\/p>\n
In the initial STOPDAPT-2 trial, which included patients with stable coronary artery disease (CAD) and with acute coronary syndrome (ACS) undergoing PCI, a strategy of 1 month of dual antiplatelet therapy (DAPT) followed by clopidogrel monotherapy was associated with significant reduction in the composite of cardiovascular and bleeding events when compared to standard-of-care 12 months of DAPT. While the net clinical benefit was observed in the overall population, the trial was not sufficiently powered to compare the effect of the 2 treatment strategies among ACS patients alone.<\/p>\n
<\/p>\n
To address this concern, the subsequent STOPDAPT-2 ACS trial, which was protocoled in a similar fashion to the original STOPDAPT-2 trial, enrolled exclusively ACS patients. Notably, the trial was designed to demonstrate, with sufficient statistical power, the safety and efficacy of a 1-month DAPT strategy followed by clopidogrel monotherapy. Nonetheless, while the initial STOPDAPT-2 trial demonstrated non-inferiority and superiority of 1-month DAPT, its sister ACS trial fell short for the same primary endpoint and failed to match the original results.<\/p>\n
The present pooled analysis combined the total cohort of ACS patients, who were enrolled in both the original STOPDAPT-2 trial and the subsequent STOPDAPT-2 ACS trial. A total of nearly 6,000 patients were included, one-third of whom were considered of high-bleeding risk. The primary endpoint was the combination of thrombotic and bleeding outcomes, namely CV death, MI, stent thrombosis, and TIMI major\/minor bleeding.<\/p>\n
The total cohort analysis of STOPDAPT-2 was presented as a late-breaking clinical trial at TCT 2021 in Orlando, FL in a joint presentation by Dr. Yuki Obayashi, MD and Dr. Ko Yamamoto (Kyoto University Hospital, Japan). Compared with 12 months of DAPT, there was a numerical increase in the rate of CV thrombotic events in the 1-month DAPT group, but notably this increase did not reach statistical significance, and the 2 strategies were therefore considered non-inferior to one another. With regards to bleeding risk, the 1-month DAPT strategy \u2013 as expected – was associated with significantly fewer major bleeding events. Furthermore, subgroup analyses, particularly high-bleeding risk status and PCI complexity, demonstrated no significant variation compared to the the overall findings.<\/p>\n
According to the investigators, the non-inferiority observed with 1-month DAPT with regards to CV events was, at least in part, attributed to the expanded use of newer generation drug-eluting stents that generally require less duration of DAPT compared to their older counterparts. While the overall analysis favored the 1-month DAPT strategy, the investigators nonetheless also acknowledged the need for additional studies to further explore the optimal duration of DAPT in the post-ACS setting.<\/p>\n","protected":false},"excerpt":{"rendered":"
Despite advances in therapy, the choice and duration of antiplatelet therapy following percutaneous coronary intervention (PCI) remains an area of active debate. While it has been postulated that long-term dual antiplatelet therapy (DAPT) are associated with reduced rates of thrombotic events, these benefits have been \u00a0offset by increased bleeding risk. In the initial STOPDAPT-2 trial, […]<\/p>\n","protected":false},"author":35656,"featured_media":9709,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"aside","meta":{"footnotes":""},"categories":[829],"tags":[47,185],"ppma_author":[1063],"class_list":{"0":"post-27547","1":"post","2":"type-post","3":"status-publish","4":"format-aside","5":"has-post-thumbnail","7":"category-tct-2021","8":"tag-featured","9":"tag-news","10":"post_format-post-format-aside","11":"author-wallyomar"},"authors":[{"term_id":1063,"user_id":35656,"is_guest":0,"slug":"wallyomar","display_name":"WallyOmar","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/a6f105232fa7a2d967ba5e1e19104eeb3b45b6d9e588caf37850c2d596fbcae1?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/27547","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/35656"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27547"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/27547\/revisions"}],"predecessor-version":[{"id":27565,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/27547\/revisions\/27565"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/9709"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27547"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27547"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27547"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=27547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}