Photo Credit: iStock.com/Akarawut Lohacharoenvanich
A 3-month regimen of dual antiplatelet therapy (DAPT) appeared to be the optimal treatment duration after percutaneous coronary intervention (PCI) to balance the risk for ischemic events and bleeding, irrespective of bleeding risk, results of the HOST-BR trial showed.
The HOST-BR study included patients who underwent PCI and stratified them according to bleeding risk. In the high ARC bleeding risk group, 1,598 participants were randomly assigned to 1 month or 3 months of DAPT. In the low ARC bleeding risk group, 3,299 participants received either a 3-month or a 12-month regimen of DAPT. The three co-primary endpoints were net adverse clinical events (NACE), major adverse cardiac or cerebral events (MACCE), and BARC bleeding (2, 3, 5) at 1 year of follow-up. Hyo-Soo Kim, Seoul National University Hospital, Korea, presented the key findings.
In the high-risk stratum, the non-inferiority criterium for the first primary endpoint was not met, with event rates of 18.4% in the 1-month treatment group and 14.0% in the 3-month treatment group (HR 1.34; P=0.82). For MACCE, the 1-month treatment arm displayed a higher event rate as well (9.8% vs 5.8%; HR 1.72; P=0.96). The bleeding risk was 13.8% in the 1-month treatment group and 15.8% in the 3-month treatment group (HR 0.85; P=0.23).
In the low-risk stratum, the risk for NACE was 4.4% in the 12-month treatment group and 2.9% in the 3-month treatment group, meeting the endpoint for non-inferiority (HR 0.66; P<0.001). The corresponding event rates for MACCE were 2.3% and 2.2% (HR 0.98; P=0.008). Finally, the bleeding risk was higher in the 12-month treatment group than in the 3-month treatment group (11.7% vs 7.4%; HR 0.63; P<0.001).
“A 3-month regimen of DAPT would be the optimal duration after PCI to meet the balance of thrombosis and bleeding,” Dr. Kim concluded.
Medical writing support was provided by Robert van den Heuvel.
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