One- Versus Three-Month Dual Antiplatelet Therapy in High Bleeding Risk Patients With Chronic Kidney Disease

Shortening the duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) was shown to be effective and safe in patients at high bleeding risk (HBR). We aimed to investigate the effect of 1-month versus 3-month DAPT on outcomes after DES in HBR patients with or without chronic kidney disease (CKD). Data from three prospective single-arm studies (XIENCE Short DAPT Program) enrolling HBR patients after successful coronary implantation of cobalt-chromium everolimus-eluting stent (Xience, Abbott) were analyzed. Subjects were eligible for DAPT discontinuation at 1 month or 3 months if free from ischemic events. The primary endpoint was all-cause death or any myocardial infarction. The key secondary endpoint was Bleeding Academic Research Consortium (BARC) type 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after PCI. CKD was defined as baseline creatinine clearance <60 mL/min. Out of 3,286 patients, 1,432 (43.6%) had CKD. One- versus 3-month DAPT was associated with a similar 12-month risk of the primary outcome irrespective of CKD status (CKD: 9.5% versus 10.9%, adjusted HR 0.86, 95% CI 0.60-1.22; no-CKD: 6.6% versus 5.6%, adjusted HR 1.15, 95% CI 0.77-1.73; p-interaction 0.299). BARC 2-5 bleeding rates were numerically but not significantly lower with 1 versus 3-month DAPT in both CKD (9.9 % versus 12%) and no-CKD (6.4% versus 9.0%) patients. In conclusion, in HBR patients, 1- versus 3-month DAPT was associated with a similar risk of ischemic complications and a trend toward fewer bleeding events at 12 months after PCI, irrespective of CKD status.