Abbreviated Dual Antiplatelet Therapy After Percutaneous Coronary Intervention Among Patients with High Bleeding Risk - European Medical Journal

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Abbreviated Dual Antiplatelet Therapy After Percutaneous Coronary Intervention Among Patients with High Bleeding Risk

1 Mins
Interventional Cardiology
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Authors:
Manveer Singh , 1 * Etienne Puymirat , 1 Michel Zeitouni , 2 Céline Lambert , 3 Grégoire Rangé; , 4 on behalf of FRANCE-PCI investigators
  • 1. Cardiology Department, Hôpital Européen Georges-Pompidou, Paris, France
  • 2. Cardiology Department, AP-HP Hôpital Universitaire Pitié-Salpêtrière, Paris, France
  • 3. Biostatistics Unit, DRCI, CHU Clermont-Ferrand, France
  • 4. Cardiology Department, Les Hôpitaux de Chartres, Le Coudray, France
*Correspondence to [email protected]
Disclosure:

Rangé has received grants or contracts, consulting fees, and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from Abbott Vascular and Shockwave; and is the President of the France PCIAssociation. The other authors have declared no conflicts of interest.

Keywords:
Dual antiplatelet therapy (DAPT), high bleeding risk (HBR), percutaneous coronary intervention (PCI).
Citation:
EMJ Int Cardiol. ;14[1]:34-35. https://doi.org/10.33590/emjintcardiol/JTA9HZ6S.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND AND AIMS

While dual antiplatelet therapy (DAPT) effectively reduces thrombotic and ischaemic complications following percutaneous coronary intervention (PCI), it is associated with an increased risk of bleeding, particularly among patients with high bleeding risk (HBR).1 Although recent guidelines advocate abbreviated DAPT (≤3 months) in this population, the uptake of these strategies in routine clinical practice remains insufficiently described.2-4 The authors sought to assess real-world prescription patterns of abbreviated DAPT after PCI according to bleeding risk status, and to identify factors associated with prolonged DAPT use in patients with HBR using the nationwide FRANCE-PCI registry.5

MATERIALS AND METHODS

This analysis included consecutive patients undergoing PCI for acute or chronic coronary syndrome between 2014–2023 in 56 French centres participating in the prospective FRANCE-PCI registry.6 Patients alive at 1 year with available DAPT duration data were included. HBR was pragmatically defined by the presence of at least one of the following criteria: age ≥75 years, chronic oral anticoagulation, prior stroke, or chronic kidney disease. Multivariable mixed-effects logistic regression analysis was performed to identify predictors of prolonged DAPT (>3 months) among patients with HBR.

RESULTS

Among 115,992 patients included, 48,028 (41.4%) fulfilled HBR criteria. Despite guideline recommendations favouring shorter antiplatelet strategies in this population, abbreviated DAPT was prescribed in only 23.1% of patients with HBR compared with 3.6% of patients without HBR (p<0.001; (Figure 1).

Figure 1: Real-world use of abbreviated DAPT after PCI in patients with HBR.
ACS: acute coronary syndrome; CCS: chronic coronary syndrome; DAPT: dual antiplatelet therapy; HBR: high bleeding risk; PCI: percutaneous coronary intervention.

Within the HBR subgroup, several clinical and procedural characteristics remained independently associated with prolonged DAPT use, including older age (odds ratio [OR]: 1.02; 95% CI: 1.02–1.03), female sex (OR: 1.18; 95% CI: 1.11–1.25), diabetes (OR: 1.15; 95% CI: 1.08–1.22), prior stroke (OR: 1.54; 95% CI: 1.39–1.69), chronic kidney disease (OR: 1.24; 95% CI: 1.15–1.34), acute coronary syndrome presentation (OR: 1.52; 95% CI: 1.44–1.61), and total stent length ≥60 mm (OR: 1.18; 95% CI: 1.09–1.28). Over the study period, abbreviated DAPT use progressively increased among patients with HBR, although prolonged DAPT remained the predominant strategy overall.

CONCLUSION

In this large, contemporary, nationwide PCI registry, fewer than one in four patients with HBR received abbreviated DAPT, despite current guideline recommendations. DAPT duration remained strongly influenced by markers of ischaemic and procedural complexity, underscoring the persistent challenges of balancing bleeding and ischaemic risks in routine clinical practice, and highlighting the gap between randomised trial evidence and real-world management.

References
Urban P et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J. 2019;40(31):2632-53. Byrne RA et al. 2023 ESC Guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2023;44(38):3720-826. Valgimigli M et al. Dual antiplatelet therapy after PCI in patients at high bleeding risk. N Engl J Med. 2021;385(18):1643-55. Mehran R et al. 3- or 1-month DAPT in patients at high bleeding risk undergoing everolimus-eluting stent implantation. JACC Cardiovasc Interv. 2021;14(17):1870-83. Puymirat E et al. Real-world use of abbreviated dual antiplatelet therapy after PCI in high bleeding risk patients. Abstract A96111EP. EuroPCR,  19-22 May, 2026. Rangé G et al. The France PCI registry: design, methodology and key findings. Arch Cardiovasc Dis. 2023;116(11):489-97.

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