Long-term P2Y12 inhibitor monotherapy after PCI reduces bleeding at 3 years vs. DAPT
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Long-term P2Y12 inhibition after PCI reduced bleeding at 3 years compared with dual antiplatelet therapy, with no significant differences observed for ischemic events, according to new data from the SMART-CHOICE trial.
“In this 3-year follow-up of a randomized clinical trial, P2Y12 inhibitor monotherapy after 3 months of DAPT was found to be comparable with prolonged DAPT for preventing ischemic events. Furthermore, P2Y12 inhibitor monotherapy resulted in a significantly lower rate of major bleeding for up to 3 years,” Ki Hong Choi, MD, of the division of cardiology in the department of medicine at Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea, and colleagues wrote. “Results of the current study suggest that long-term maintenance of P2Y12 inhibitor monotherapy may be a promising antiplatelet strategy after percutaneous coronary intervention.”
These findings were published in JAMA Cardiology.
In the original SMART-CHOICE trial, researchers compared 3-month DAPT followed by P2Y12 inhibitor monotherapy with 12-month DAPT in 2,993 patients who underwent PCI (mean age, 65 years; 73% men).
As Healio previously reported, 3-month DAPT after PCI followed by P2Y12 inhibitor monotherapy did not confer any increased risk for MI, death or stroke at 1 year compared with 1-year DAPT.
For the present analysis, researchers evaluated the 3-year outcomes of the SMART-CHOICE trial, with a primary endpoint of a composite of ischemic events including all-cause death, MI or stroke. Secondary endpoints included bleeding (Bleeding Academic Research Consortium [BARC] types 2-5) and major bleeding (BARC types 3-5).
At 3 years, the incidence of the primary endpoint was not significantly different between patients who received P2Y12 inhibitor monotherapy after 3 months of DAPT compared with those who received 1 year of DAPT after PCI (HR = 1.06; 95% CI, 0.79-1.44; P = .69).
However, researchers observed a reduction in both bleeding (HR = 0.39; 95% CI, 0.28-0.55; P < .001) and major bleeding (HR = 0.56; 95% CI, 0.31-0.99; P = .048) among the group assigned 3-month DAPT followed by P2Y12 inhibitor monotherapy compared with the 1-year DAPT group.
“The current results of extended follow-up from the SMART-CHOICE trial support evidence of aspirin dropping strategy with indefinite use of P2Y12 inhibitor after minimum use of DAPT in patients who underwent PCI,” the researchers wrote. “Future A-CLOSE ... and SMART-CHOICE III trials will be helpful to confirm our findings.”
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