New insights on optimal duration of dual antiplatelet therapy after stent implantation

Medical Xpress / American College of Cardiology's Annual Scientific Session (ACC.25) ^ | March 31, 2025 | Hyo-Soo Kim, MD, Ph.D. et al

[ConservativeMind]

Patients who have a stent implanted to open a coronary artery face dual risks of developing blood clots and of having excessive bleeding in the months following the procedure. While routine treatment with aspirin plus a second anti-clotting drug, known as dual antiplatelet therapy (DAPT), can prevent blood clots, these drugs may increase risk for bleeding.

Researchers report for patients at high risk for bleeding following stent implantation, three months of DAPT was better than one month at reducing heart attacks, strokes and other adverse events without increasing bleeding risk. For patients with a low risk for bleeding, the study found three months of DAPT was comparable to 12 months for reducing adverse events and better than 12 months for reducing bleeding risk.

The trial, known as HOST-BR, enrolled 4,900 patients who had high bleeding risk (HBR) and low bleeding risk (LBR).

All patients underwent a procedure to implant one or more stents in narrowed coronary arteries.

At 12 months, in the HBR group, patients who received three months of DAPT did better on the first and second components of the primary endpoint than those who received one month of therapy (14.4% vs. 18.4%, respectively, for the first component; 6.4% vs. 10.3%, respectively, for the second component). Bleeding episodes (the third component) were not significantly different whether patients received one or three months of treatment (15.6% vs. 17.9%, respectively).

In the LBR group, outcomes were similar for patients in the three months and 12 months of treatment groups on the first and second components of the primary endpoint (4% vs. 5.7%, respectively, for the first component; 2.5% vs. 2.8%, respectively, for the second component). Patients receiving three months of treatment had significantly fewer bleeding episodes (the third component) than those who received 12 months of treatment (9.2% vs. 13.7%, respectively).

[ConservativeMind]

In sum, this says if you just got a stent, for those people deemed at high risk for bleeding, take the dual treatment (aspirin and other prescribed drug) for three months. For those at low risk for bleeding, just take the dual drugs three months, and not longer.

Of course, your doctor will need this study to help understand your request.

[ConservativeMind]

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[arkfreepdom]

This is very good info because frequently other treatments for other issues are delayed until one year of DAPT. Colonoscopies just one.

[Fido969]

I had a couple of stints put in last year, and am duel anti-platelet therapy, namely low dose aspirin and prasugrel. They tell me the prasugrel is for a year, and the aspirin for life.

I haven’t had any noticeable bleeding issues, although when they take a blood draw they wrap me up pretty well I think just out of caution. It will be a year next month, so I’ll just finish the program.

[srmanuel]

I had open heart surgery last June to replace my aortic valve and repair an aortic aneurysm, I chose a pig valve instead of a mechanical valve, I was on eliquis for 3 months in addition to a baby aspirin.

[neverevergiveup]

Will have to see the full study when it is published, but the groupings they used are a bit unusual. The primary goal of this study should be to determine if there is a greater risk of stent thrombosis with 3 months of DAPT vs 12 months, and to compare this to whether there is a greater bleeding risk (GI, CNS or other) with 12 months of DAPT vs just 3 months.

Further, to make the stent thrombosis comparisons accurate you would have to ensure that the groups were similar in the number of stents put in each patient, the number of vessels treated, the diameter of the stents after post-dilation, and the length of the stented segments.

Anyway, thanks for posting. Will read the study when it’s available in full.

[sauropod]

Bkmk