Ajay J. Kirtane, M.D., associate professor of medicine at Columbia University Irving Medical Center and director of the cardiac catheterization laboratories at NewYork-Presbyterian (NYP) Hospital, shares the findings of the late-breaking EVOLVE Short DAPT study presented as a late-breaking trial at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. It evaluated the safety of early dual antiplatelet therapy (DAPT) discontinuation in patients with high bleeding risk treated with the a Boston Scientific Synergy bioabsorbable polymer coated drug-eluting stent (DES).
With the advancement of new DES technologies using thinner struts and new types of drug-carrier polymer techniques, the risk of late-stennt thrombosis has been greatly reduced, meaning there is less need for long-term DAPT. For patients who are at high risk for bleeding, who have ulcers or other types of gastrointestinal (GI) bleeding, or those going into surgery, it would be beneficial to reduce the time period for DAPT, and several late-breaking trials examined this at TCT 2019.
Here are the other late-breaking DAPT studies:
- TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy vs Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing PCI.
- Onyx ONE: A Randomized Trial of a Durable-Polymer Drug-Eluting Stent vs a Polymer-Free Drug-Coated Stent in Patients at High Risk of Bleeding Treated With 1-Month DAPT.
- IDEAL-LM: A Randomized Trial of a Bioabsorbable Polymer DES With 4-Month DAPT vs a Durable Polymer DES With 12-Month DAPT in Patients With Left Main Coronary Artery Disease.
- MODEL U-SES: A Single Arm Study of 3-Month DAPT in Patients at High Bleeding Risk Treated A Bioabsorbable Polymer-Based Sirolimus-Eluting Stent.
- AUGUSTUS ACS: A 2 × 2 Factorial Randomized Trial of Apixaban vs Warfarin and Aspirin vs Placebo in Patients With Atrial Fibrillation and an Acute Coronary Syndrome.
- TWILIGHT: Thrombogenicity Substudy: Impact of Ticagrelor Alone vs Ticagrelor Plus Aspirin on Ex-Vivo Blood Thrombogenicity in High-Risk Patients Undergoing PCI.