Nav: Home

Stopping DAPT after one-month improved outcomes in stent patients

March 18, 2019

Patients who stopped taking aspirin one month after receiving a stent in the heart's arteries but continued taking the P2Y12 inhibitor clopidogrel fared significantly better after one year compared with those who followed the standard practice of continuing both medications, according to research presented at the American College of Cardiology's 68th Annual Scientific Session. Stopping aspirin early was found to be superior in terms of the trial's primary endpoint, a composite of death from cardiovascular causes, heart attack, clotting near the stent, stroke and major bleeding.

The trial sheds new light on the optimal way to balance the risk of clotting and bleeding in patients who undergo procedures to clear blocked arteries. Giving these patients antiplatelet medications that reduce the body's ability to clot blood can reduce the chance of clot-related problems such as heart attacks and stroke, but these medications can also lead to uncontrolled bleeding.

The newest generation of stents--mesh tubes used to prop an artery open--release drugs that prevent new blockages from forming around the stent. While current guidelines recommend patients take aspirin and a P2Y12 inhibitor such as clopidogrel for at least 12 months after receiving a stent, a strategy known as dual antiplatelet therapy (DAPT), doctors have sought to determine whether this is the best combination of drugs to use with newer drug-eluting stents. The new trial assessed whether stopping aspirin after one month but continuing clopidogrel alone for 12 months might be a better approach.

"Standard 12-month DAPT is currently recommended by the guidelines, and one-month DAPT has not yet been implemented in daily clinical practice," said Hirotoshi Watanabe, MD, research associate at Kyoto University Graduate School of Medicine and the study's lead author. "According to our findings, one-month DAPT followed by clopidogrel monotherapy could be a good option after drug-eluting stent implantation with an advantage of fewer bleeding events."

The trial, known as STOPDAPT-2, enrolled 3,009 patients who received a drug-eluting stent at 89 medical centers in Japan. Patients who were taking oral anticoagulants, could not tolerate clopidogrel or had a history of bleeding in the brain were excluded. Half of the patients were randomly assigned to receive standard DAPT. The other half took aspirin plus clopidogrel or prasugrel (another P2Y12 inhibitor) for the first month and took clopidogrel only after that, with patients who took prasugrel initially switching to clopidogrel after the first month.

In the one-month DAPT group, aspirin was stopped at one month in 96 percent of patients, while DAPT was continued up to one year in 88 percent of patients in the standard 12-month DAPT group. Overall, stopping aspirin after one month reduced the risk of adverse events by 36 percent. After one year, 2.4 percent of patients who stopped aspirin after one month experienced the composite primary endpoint compared to 3.7 percent among those following standard DAPT.

An analysis of secondary endpoints revealed stopping aspirin after one month significantly reduced the rate of bleeding. Overall, 0.4 percent of those stopping aspirin experienced major bleeding compared to 1.5 percent among those following standard DAPT. Furthermore, stopping aspirin after one month did not increase the events related to clotting, known as ischemic events, in a secondary endpoint that included a composite of death from cardiovascular causes, heart attack, clotting around the stent or stroke.

"One-month DAPT followed by clopidogrel monotherapy as compared with standard 12-month DAPT reduced the bleeding events and did not increase the ischemic events," Watanabe said. "That lead to a net clinical benefit for both ischemic and bleeding outcomes."

One limitation of the study is that most of the participants were at low or intermediate risk for ischemic events. Watanabe said it is unknown whether the study can be extrapolated to apply in higher-risk patients. To answer this question, the researchers are continuing to enroll patients in the trial who have acute coronary syndrome, a group that is at higher risk for ischemic events.

The study was also open-label, meaning that patients knew which drugs they had been assigned to take. After 12 months, the patients who stopped aspirin were instructed to continue taking clopidogrel, while the patients in the DAPT arm were instructed to discontinue clopidogrel but continue taking aspirin. The researchers plan to continue to track outcomes until five years after patients received their stent.
-end-
The study received funding from Abbott Vascular Japan, Co., Ltd.

The ACC's Annual Scientific Session will take place March 16-18, 2019, in New Orleans, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch, @ACCMediaCenter and #ACC19 for the latest news from the meeting.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.

American College of Cardiology

Related Heart Attack Articles:

Where you live could determine risk of heart attack, stroke or dying of heart disease
People living in parts of Ontario with better access to preventive health care had lower rates of cardiac events compared to residents of regions with less access, found a new study published in CMAJ (Canadian Medical Association Journal).
Activated T-cells drive post-heart attack heart failure
Chronic inflammation after a heart attack can promote heart failure and death.
ICU care for COPD, heart failure and heart attack may not be better
Does a stay in the intensive care unit give patients a better chance of surviving a chronic obstructive pulmonary disease (COPD) or heart failure flare-up or even a heart attack, compared with care in another type of hospital unit?
Heart attack treatment might be in your face
Researchers at the University of Cincinnati have received $2.4 million in federal funding to pursue research on a novel cell therapy that would repair heart damage using modified cells taken from the patient's own facial muscle.
Tissue engineering advance reduces heart failure in model of heart attack
Researchers have grown heart tissue by seeding a mix of human cells onto a 1-micron-resolution scaffold made with a 3-D printer.
Study shows functional effects of human stem cell delivery to heart muscle after heart attack
Researchers delivered human stem cells seeded in biological sutures to the damaged heart muscles of rats following induced acute myocardial infarction and assessed the effects on cardiac function one week later.
Younger heart attack survivors may face premature heart disease death
For patients age 50 and younger, the risk of premature death after a heart attack has dropped significantly, but their risk is still almost twice as high when compared to the general population, largely due to heart disease and other smoking-related diseases The risk of heart attack can be greatly reduced by quitting smoking, exercising and following a healthy diet.
After the heart attack: Injectable gels could prevent future heart failure (video)
During a heart attack, clots or narrowed arteries block blood flow, harming or killing cells in the heart.
Heart failure after first heart attack may increase cancer risk
People who develop heart failure after their first heart attack have a greater risk of developing cancer when compared to first-time heart attack survivors without heart failure, according to a study today in the Journal of the American College of Cardiology.
1 in 4 patients develop heart failure within 4 years of first heart attack
One in four patients develop heart failure within four years of a first heart attack, according to a study in nearly 25,000 patients presented today at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure by Dr.

Related Heart Attack Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#530 Why Aren't We Dead Yet?
We only notice our immune systems when they aren't working properly, or when they're under attack. How does our immune system understand what bits of us are us, and what bits are invading germs and viruses? How different are human immune systems from the immune systems of other creatures? And is the immune system so often the target of sketchy medical advice? Those questions and more, this week in our conversation with author Idan Ben-Barak about his book "Why Aren't We Dead Yet?: The Survivor’s Guide to the Immune System".