Study Compares Duration of Dual Antiplatelet Therapy in Acute Coronary Syndrome

Treatment with 3 months of dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) who have a drug-eluting stent (DES) was found to be non-inferior to year-long treatment with DAPT, according to trial results reported at the Transcatheter Cardiovascular Therapeutics (TCT) 2017 scientific symposium being held in Denver, this week.

In the REDUCE trial, researchers enrolled 1500 patients with acute coronary syndrome treated with the COMBO dual therapy stent. The participants were randomly assigned to either 3 months or 12 months of DAPT. Recent guidelines recommend 6-12 months of DAPT for patients with stable angina treated with new generation DES, the researchers noted, although the optimal duration of DAPT in patients with ACS who are treated with DES remains unclear.

Because long-term DAPT can increase risk of major bleeding complications, the researchers aimed to determine whether DAPT could be reduced in ACS patients while avoiding thrombotic complications. The patients were scheduled for clinical follow-ups at 3, 6, 12, and 24 months. The researchers evaluated a composite of all-cause mortality, myocardial infarction, stent thrombosis (ST), stroke, target-vessel revascularization, and bleeding at 12 months as the primary endpoint.

The results indicated no difference in the primary endpoint between 3 and 12 months of DAPT. Additionally, the results demonstrated that major bleeding rates were similar in both treatment arms, with similar rates of overall mortality, cardiac mortality, and definite/probably ST. Among patients with ACS who were treated with the COMBO stent, 3-month DAPT was found to be non-inferior to 12-month DAPT.

Harry Suryapranata, MD, PhD, principal study investigator who presented on behalf of the REDUCE trial investigators, noted that a shorter DAPT strategy could be considered, if necessary, in ACS patients. However, future larger trials are needed to further investigate and confirm the safety of short-term DAPT regimen in ACS patients in the era of new ADP antagonists and new generation DES, Dr. Suryapranata and colleagues concluded.

Reference

Suryapranta H. REDUCE: A randomized trial of 3-month vs 12-month DAPT after implantation of a bioabsorbable polymer-based metallic DES with a luminal CD34+ antibody coating in patients with ACS. Presented at: Transcatheter Cardiovascular Therapeutics Scientific Symposium, October 30-November 2, 2017. Denver.