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In individuals with diabetes undergoing PCI, Clopidogrel monotherapy reduces major bleeding events.
In diabetes patients undergoing percutaneous coronary intervention (PCI) following a very brief dual antiplatelet therapy (DAPT), Clopidogrel monotherapy was associated with an effective reduction in major bleeding events without a rise in cardiovascular events. This study's objective was to assess the safety and effectiveness of Clopidogrel monotherapy during PCI.
A subgroup assessment was done based on diabetes in STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2) Total Cohort (N = 5,997) (STOPDAPT-2, n = 3,009; STOPDAPT-2 ACS [Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 for Patients With ACS], n = 2,988), that randomly investigated one-month DAPT succeeded by Clopidogrel monotherapy along with twelve-month DAPT with Aspirin and Clopidogrel following cobalt-chromium everolimus-eluting stent implantation.
The composite of TIMI [Thrombolysis In Myocardial Infarction] major or mild bleeding or cardiovascular (myocardial infarction, cardiovascular mortality, definite stent thrombosis, or stroke) endpoints at 1 year was the key endpoint ascertained. Notably, 2,030 people (33.8%) had diabetes in comparison with 3967 without it (66.2%).
Without regard to diabetes, the risk of one-month DAPT relative to twelve-month DAPT was not statistically profound for the key outcome (nondiabetes, 2.46% vs 2.49% [HR: 0.99]; diabetes, 3.58% vs 4.12% [HR: 0.87]) and for the cardiovascular endpoint (nondiabetes, 1.95% vs 1.43% [HR: 1.38]; diabetes, 3.28% vs 3.05% [HR: 1.10]). However, it was lower for the bleeding endpoint (nondiabetes, 0.61% vs 1.21% [HR: 0.51]; diabetes, 0.30% vs 1.50% [HR: 0.20]).
Irrespective of diabetes, Clopidogrel monotherapy following 1-month DAPT in comparison with 12-month DAPT diminished significant bleeding events without elevating cardiovascular events. However, the results must be viewed as hypothesis-generating, particularly in individuals suffering from acute coronary syndrome, owing to inconclusive findings of the STOPDAPT-2 ACS trial's results.
JACC: Cardiovascular Interventions
Clopidogrel Monotherapy After 1-Month Dual Antiplatelet Therapy in Patients With Diabetes Undergoing Percutaneous Coronary Intervention
Ko Yamamoto et al.
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