- Dual antiplatelet agent therapy (DAPT) is essential in treating PCI patients. DAPT can
minimize thrombotic adverse events that occur not only at the stented lesion, but along
the whole coronary tree. However, DAPT has a critical side effect of increasing bleeding
complications. Addressing the clinical imperatives of lowering bleeding while preserving
ischemic benefit requires therapeutic strategies that decouple thrombotic from
hemorrhagic risk.
- Recently, the ARC definition of high bleeding risk (HBR) has been published, so as to
stress the need of optimal DAPT treatment in HBR patients. Due to the definitely higher
bleeding risk in HBR patients, it would be rather more straight forward to titrate the
optimal DAPT duration in these patients. In this line, many studies are in progress on
HBR patients, with an ultra-short DAPT duration (i.e. Leaders free, Onyx ONE, Master
DAPT, Xience 28, Xience 90, Evolve short DAPT trial, etc.).
- As a counteract to the definition of HBR, there is a concept of LBR. Due to the
relatively vague ischemic/bleeding risk in LBR patients, balancing ischemic and bleeding
complications post-PCI is more difficult in LBR patients, which may be a more important
dilemma for clinicians. In this regards, limited evidence exists on the optimal duration
of DAPT in LBR patients. Various previous studies that have evaluated the optimal DAPT
in PCI populations, did not have the concept of HBR or LBR, making interpretation
difficult.
- Therefore, this study is planning to compare the efficacy and safety of different DAPT
durations, in patients stratified according to the ARB-HBR definition.