Background: Individuals with coronary artery disease (CAD) who have undergone a percutaneous coronary intervention (PCI) are at an increased risk for adverse coronary events. Management with dual antiplatelet therapy (DAPT) has been indicated in this group, however, DAPT significantly increases the risk of bleeding. Objectives: This study aimed to evaluate aspirin versus clopidogrel and aspirin on major adverse cardiac and cerebrovascular events (MACCE) and risk of bleeding in individuals already on DAPT for one year after undergoing PCI. Methods: This was a single-center, double-arm, interventional, prospective study. A total of 956 individuals who had undergone PCI and were on DAPT for a year were enrolled. After calculating DAPT scores, individuals with DAPT scores ≥2 were assigned to the aspirin and clopidogrel group, and those with DAPT scores <2 were prescribed aspirin alone. The participants were followed for one year to collect data on incidences of MACCE and significant bleeding. Results: The group on clopidogrel and aspirin demonstrated a significantly lower rate of MACCE when compared to those on aspirin alone (p = 0.003). However, stent thrombosis, stroke, and myocardial infarction (MI) did not significantly differ in an inter-group comparison. The rate of moderate bleeding was greater in the clopidogrel group; however, the difference was not found to be statistically significant (p = 0.19). Conclusions: Continuing DAPT for a period between 12 and 24 months after PCI in individuals with a DAPT score ≥2 had favorable outcomes in reducing coronary adverse events without resulting in significant bleeding.
References
[1]
Helft, G., Steg, P.G., Le Feuvre, C., Georges, J., Carrie, D., Dreyfus, X., et al. (2015) Stopping or Continuing Clopidogrel 12 Months after Drug-Eluting Stent Placement: The OPTIDUAL Randomized Trial. EuropeanHeartJournal, 37, 365-374. https://doi.org/10.1093/eurheartj/ehv481
[2]
Bordet, J., Negrier, C., Dargaud, Y. and Quellec, S.L. (2016) Comparison of Current Platelet Functional Tests for the Assessment of Aspirin and Clopidogrel Response: A Review of the Literature. ThrombosisandHaemostasis, 116, 638-650. https://doi.org/10.1160/th15-11-0870
[3]
Yao, Y., Tang, X., Zhang, J., He, C., Ma, Y., Xu, J., et al. (2016) Association of PEAR1 Genetic Variants with Platelet Reactivity in Response to Dual Antiplatelet Therapy with Aspirin and Clopidogrel in the Chinese Patient Population after Percutaneous Coronary Intervention. ThrombosisResearch, 141, 28-34. https://doi.org/10.1016/j.thromres.2016.02.031
[4]
Kereiakes, D.J., Yeh, R.W., Massaro, J.M., Cutlip, D.E., Steg, P.G., Wiviott, S.D., et al. (2016) DAPT Score Utility for Risk Prediction in Patients with or without Previous Myocardial Infarction. JournaloftheAmericanCollegeofCardiology, 67, 2492-2502. https://doi.org/10.1016/j.jacc.2016.03.485
[5]
Doenst, T., Haverich, A., Serruys, P., Bonow, R.O., Kappetein, P., Falk, V., et al. (2019) PCI and CABG for Treating Stable Coronary Artery Disease: JACC Review Topic of the Week. JournaloftheAmericanCollegeofCardiology, 73, 964-976. https://doi.org/10.1016/j.jacc.2018.11.053
[6]
Toyota, T., Shiomi, H., Morimoto, T., Natsuaki, M. and Kimura, T. (2017) Short versus Prolonged Dual Antiplatelet Therapy (DAPT) Duration after Coronary Stent Implantation: A Comparison between the DAPT Study and 9 Other Trials Evaluating DAPT Duration. PLOSONE, 12, e0174502. https://doi.org/10.1371/journal.pone.0174502
[7]
Capodanno, D., Huber, K., Mehran, R., Lip, G.Y.H., Faxon, D.P., Granger, C.B., et al. (2019) Management of Antithrombotic Therapy in Atrial Fibrillation Patients Undergoing PCI: JACC State-of-the-Art Review. JournaloftheAmericanCollegeofCardiology, 74, 83-99. https://doi.org/10.1016/j.jacc.2019.05.016
[8]
Costa, F., van Klaveren, D., James, S., Heg, D., Räber, L., Feres, F., et al. (2017) Derivation and Validation of the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) Score: A Pooled Analysis of Individual-Patient Datasets from Clinical Trials. TheLancet, 389, 1025-1034. https://doi.org/10.1016/s0140-6736(17)30397-5
[9]
Khan, S.U., Singh, M., Valavoor, S., Khan, M.U., Lone, A.N., Khan, M.Z., et al. (2020) Dual Antiplatelet Therapy after Percutaneous Coronary Intervention and Drug-Eluting Stents: A Systematic Review and Network Meta-Analysis. Circulation, 142, 1425-1436. https://doi.org/10.1161/circulationaha.120.046308
[10]
Luo, L., Wang, S., Tang, K., Yang, X., Wu, J., Wang, D., et al. (2022) Efficacy and Safety of Dual Antiplatelet Therapy after Percutaneous Coronary Drug-Eluting Stenting: A Network Meta-Analysis. Medicine, 101, e31158. https://doi.org/10.1097/md.0000000000031158