A groundbreaking study presented at the American College of Cardiology's Annual Scientific Session (ACC.25) offers new insights into the optimal duration of dual antiplatelet therapy (DAPT) for patients who have undergone stent implantation. The research, conducted by South Korean scientists, explores how varying durations of DAPT affect high and low bleeding risk patients. Findings suggest that three months of DAPT may be preferable for both groups, reducing adverse events without significantly increasing bleeding risks. This trial provides crucial evidence for tailoring treatment strategies to individual patient needs.
Cardiovascular specialists have long grappled with balancing clot prevention and bleeding risks following stent procedures. Routine DAPT involves aspirin combined with another anti-clotting agent, which helps prevent clots but can elevate bleeding risks, particularly in older or less healthy individuals. In this context, researchers investigated whether specific durations of DAPT could optimize outcomes based on a patient's bleeding risk profile.
Dr. Hyo-Soo Kim from Seoul National University Hospital led the HOST-BR trial, involving 4,900 participants categorized into high and low bleeding risk groups. High-risk patients averaged 73 years old, while low-risk patients were around 63 years old. All underwent stent implantation before being randomly assigned differing DAPT durations: one versus three months for high-risk patients and three versus twelve months for low-risk ones.
After twelve months of follow-up, significant differences emerged between treatment groups. Among high-risk patients, those receiving three months of DAPT experienced fewer deaths, heart attacks, strokes, and stent-related clots compared to those on one-month regimens, without increased bleeding incidents. For low-risk patients, three months of DAPT proved equally effective in preventing adverse events as twelve months yet resulted in markedly fewer bleeding episodes.
Despite its promising results, the study has limitations. Conducted exclusively in South Korea, it primarily utilized clopidogrel rather than newer medications like ticagrelor, potentially limiting applicability across diverse ethnic populations. Nevertheless, Dr. Kim believes the findings regarding optimal DAPT duration hold universal relevance regardless of drug type.
This research underscores the importance of personalized medicine approaches in managing cardiovascular conditions post-stent implantation. By identifying ideal treatment durations tailored to individual bleeding risks, healthcare providers can enhance patient safety and efficacy outcomes.