Baseline anaemia and short dual antiplatelet therapy in high bleeding risk patients undergoing percutaneous coronary intervention

Abstract

Aims In patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI), abbreviated dual antiplatelet therapy (DAPT) has been shown to reduce bleeding without increasing ischaemic risk. However, the optimal duration in specific subgroups, particularly anaemic patients, remains unclear and was the focus of this analysis. Methods and results This study included 3364 HBR patients from three prospective trials in the XIENCE Short DAPT programme who underwent PCI with cobalt-chromium everolimus-eluting stents. Anaemia was defined as Hb < 11 g/dL. The primary endpoint was all-cause death or myocardial infarction; secondary endpoints included BARC 2-5 and 3-5 bleeding. Outcomes by DAPT duration (1 vs. 3 months), defined according to study protocol, were assessed using propensity score stratification. Anaemia was present in 514 patients (15.3%). At 1 year, anaemic patients experienced higher rates of both ischaemic and bleeding events compared with non-anaemic patients. Among anaemic patients, ischaemic outcomes were similar with 1- and 3-month DAPT [15.7% vs. 16.3%; adjusted hazard ratio (adjHR) 0.94, 95% confidence interval (CI) 0.59-1.52; P = 0.807], whereas 1-month DAPT was associated with a lower incidence of major bleeding (6.1% vs. 11.1%; adjHR 0.49, 95% CI 0.24-1.00; P = 0.050). In non-anaemic patients, ischaemic and bleeding outcomes were similar irrespective of DAPT duration. Conclusion Among HBR patients undergoing PCI, abbreviated DAPT was associated with comparable ischaemic outcomes regardless of anaemia status. In patients with baseline anaemia, 1-month DAPT was associated with lower major bleeding without an apparent ischaemic trade-off. [GRAPHICS]