The following is a summary of “Optimal antiplatelet therapy for high bleeding and ischemic RISK patients – OPT-BIRISK,” published in the May 2024 issue of Cardiology by Kumbhani et al.
Researchers conducted a prospective study assessing clopidogrel alone against dual antiplatelet therapy (DAPT) after undergoing a drug-eluting stent (DES) for percutaneous coronary intervention (PCI) called acute coronary syndrome (ACS).
They randomly sorted 7,758 eligible patients, with an average age of 65 and 41% females, into either the clopidogrel-only group or the continued DAPT group after 9-12 months post-PCI. Later, everyone switched to taking only aspirin for 3 months and was monitored for 9 months. Inclusion criteria were at least one of high bleeding risk and high ischemic risk.
The results showed that in the clopidogrel-only bunch, about 2.5% of folks had significant bleeding issues after 9 months compared to 3.3% in the DAPT group (HR: 0.75, 95% CI: 0.57-0.97, P=0.03). Also, when comparing the two groups, they found that significant adverse cardiovascular events were experienced by 2.6% vs. 3.5% (HR: 0.74, 95% CI 0.57-0.96, P<0.001), respectively. All-cause mortality rates were 0.3% vs. 0.5% (P=0.38), and ischemic stroke rates were 0.7% vs. 0.8% (P=0.37), respectively. Additionally, there were stent clotting incidents in 0.05% vs. 0.03% of cases (P=0.57).
Investigators concluded that for patients with high-risk ACS post-stent placement, sticking with just clopidogrel is better than continuing DAPT because it helps decrease both heart-related and bleeding problems. This suggests that P2Y12 inhibitors might be more beneficial than aspirin for preventing future issues.
Source: acc.org/Latest-in-Cardiology/Clinical-Trials/2023/08/24/03/06/opt-birisk