Daily Dose: DAPT Should Remain Gold Standard for Percutaneous Coronary Intervention

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on research presented at the European Society of Cardiology 2023 Congress in Amsterdam.

The study

Researchers conducted the STOPDAPT-3 randomized, open-label clinical trial to examine the safety and efficacy of aspirin-free prasugrel monotherapy compared with 1-month dual antiplatelet therapy (DAPT) with aspirin and prasugrel in patients with acute coronary syndrome (ACS) or high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) with cobalt-chromium everolimus-eluting stents.

Investigators included patients with ACS or HBR between January 2021 and April 2023 from 72 centers in Japan. Before undergoing PCI, participants were randomly assigned in a 1:1 fashion to either prasugrel monotherapy (3.75 mg/day) or DAPT with aspirin (81-100 mg/day) and prasugrel. Both groups received a loading dose of prasugrel 20 mg.

A total of 5966 patients (mean age, 71.6 years; 23.6% women) were enrolled in the study, with 2984 in the no-aspirin group and 2982 in the DAPT group.

The findings

Investigators observed that at 1 month, the cumulative incidence of major bleeding was 4.47% in the no-aspirin group and 4.71% in the DAPT group. The cumulative incidence of the composite CV endpoint was 4.12% in the no-aspirin group and 3.69% in the DAPT group. There was no between-group difference in the incidence of all-cause mortality (2.28% vs 2.11%).

Authors' commentary

"Aspirin used for a limited period of 1 month after PCI as a component of DAPT might have exerted a protective effect on vulnerable coronary lesions, particularly in patients with ACS, without a large increase in major bleeding. DAPT should remain the standard strategy for PCI even in the new-generation drug-eluting stent era.”

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