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Lookup NU author(s): Professor Vijay KunadianORCiD
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© 2023 American College of Cardiology FoundationBackground: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients on long-term oral anticoagulation (OAC) therapy is still uncertain. Objectives: The aim of this analysis was to assess the effects of 1- vs 3-month DAPT in patients with and those without concomitant OAC included in the XIENCE Short DAPT program. Methods: The XIENCE Short DAPT program enrolled patients with high bleeding risk who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. DAPT was discontinued at 1 or 3 months in patients free from ischemic events and adherent to treatment. The effect of 1- vs 3-month DAPT was compared in patients with and those without OAC using propensity score stratification. The primary endpoint was all-cause death or any myocardial infarction (MI). The key secondary endpoint was Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after index PCI. Results: Among 3,364 event-free patients, 1,462 (43%) were on OAC. Among OAC patients, the risk for death or MI was similar between 1- and 3-month DAPT (7.4% vs 8.8%; adjusted HR: 0.74; 95% CI: 0.49-1.11; P = 0.139), whereas BARC types 2 to 5 bleeding was lower with 1-month DAPT (adjusted HR: 0.71; 95% CI: 0.51-0.99; P = 0.046). These effects were consistent in patients with and those without OAC (P for interaction = NS). Conclusions: Between 1 and 12 months after PCI, 1-month compared with 3-month DAPT was associated with similar rates of all-cause death or MI and a reduced rate of BARC types 2 to 5 bleeding, irrespective of OAC treatment.
Author(s): Valgimigli M, Spirito A, Sartori S, Angiolillo DJ, Vranckx P, de la Torre Hernandez JM, Krucoff MW, Bangalore S, Bhatt DL, Campo G, Cao D, Chehab BM, Choi JW, Feng Y, Ge J, Hermiller J, Kunadian V, Lupo S, Makkar RR, Maksoud A, Neumann F-J, Picon H, Saito S, Sardella G, Thiele H, Toelg R, Varenne O, Vogel B, Zhou Y, Windecker S, Mehran R
Publication type: Article
Publication status: Published
Journal: JACC: Cardiovascular Interventions
Year: 2023
Volume: 16
Issue: 20
Pages: 2498-2510
Print publication date: 23/10/2023
Online publication date: 04/10/2023
Acceptance date: 04/08/2023
ISSN (print): 1936-8798
ISSN (electronic): 1876-7605
Publisher: Elsevier
URL: https://doi.org/10.1016/j.jcin.2023.08.014
DOI: 10.1016/j.jcin.2023.08.014
PubMed id: 37804290
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