Short DAPT and Stenting

Dual antiplatelet therapy (DAPT) duration often depends on the patient—and it may depend on the stent as well.

Notably, the XIENCE everolimus-eluting stent (EES) has been associated with the lowest rates of early, late and very late stent thrombosis (ST).4-7 Therefore researchers have examined safety with a shortened DAPT following XIENCE implantation.8


STOPDAPT Study: XIENCE Safety Shown with 3-Month DAPT

STOPDAPT was the first prospective trial to study DAPT cessation at 3 months after EES implantation.

STOPDAPT Study Demonstrates 
XIENCE's Safety with 3-Month DAPT

1-Year XIENCE Event Rates Using 
3-Month DAPT

 

 

“Stopping DAPT at 3 months in selected patients after [XIENCE] implantation was at least as safe as the prolonged DAPT regimen adopted in the historical control group.” 

— Masahiro Natsuaki, MD, STOPDAPT Trial8

Expert's Point of View: Misperceptions About DAPT

"Long-term bleeding risks are actually increasing over time. . . . Every month that we prolong DAPT, that means that the patient has to pay a price."

Marco Valgimigli, MD

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“It was noteworthy that no definite or probable stent thrombosis occurred in [XIENCE] patients enrolled in STOPDAPT.” 

— Masahiro Natsuaki, MD, STOPDAPT Trial8


DAPT Interruption

DAPT Interruption After 1 Month9

Interruption

Timing of First DAPT Interruption and ST
Through 1 Year


More XIENCE DAPT Data:
Safety When DAPT Discontinued After 3 Months11

A study recently examined ST and DAPT use through 2 years in a large pooled sample of patients from the XIENCE family of clinical studies.11 The study revealed that discontinuing DAPT: 

  • Before 1 month was strongly associated with ST 
  • After 3 months appeared safe

Discontinuation11

Definite/Probable Stent 
Thrombosis Rates

No Permanent Discontinuation
Through 2 Years


 

The majority (80%) of STs occurred while patients were on DAPT, and most (70%) of those patients had never discontinued DAPT for even a day prior to the ST event. Thus variables other than DAPT interruption—such as risk factors—could in fact be responsible for many of the ST events.11

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  1. Morice M-C, et al. JACC. 2013;61:1122-1123.
  2. Urban P, et al. Am Heart J. 2013;165:704-709. doi: 10.1016/j.ahj.2013.01.008.
  3. SPIRIT II (n = 223), SPIRIT III (n = 669), SPIRIT IV (n = 2,458), SPIRIT V (n = 1,662), SPIRIT Women (n = 1,506), XIENCE V USA (n = 6,516), XIENCE V India (n = 931), COMPARE (n = 897), STOPDAPT (n = 1,525).
  4. Baber U, et al. JACC. 2011;58:1569–1577. doi:10.1016/j.jacc.2011.06.049.
  5. Palmerini T, et al. Lancet. 2012;379:1393–1402. doi: 10.1016/S0140-6736(12)60324-9.
  6. Palmerini T, et al. Circ Cardiovasc Interv. 2012;5:357–364. doi: 10.1161/CIRCINTERVENTIONS.111.967083.
  7. Räber L, et al. Circulation. 2012;125:1110–1121. doi: 10.1161/CIRCULATIONAHA.111.058560.
  8. Natsuaki M, et al. STOPDAPT Trial. Cardiovasc Interv Ther. 2016;31:196–209.
  9. Généreux P. Everolimus Stent Family Trials. TCT 2012.
  10. Including patients with no DAPT interruption except possibly after stent thrombosis though 365 days. DAPT was considered to be interrupted if aspirin or a thienopyridine was not taken for at least 24 hours during the 2-year follow-up period for any reason. Patients who experience early discontinuation of antiplatelet therapy should be monitored carefully for cardiac events. At the discretion of the treating physician, the antiplatelet therapy should be restarted as soon as possible per patient needs. Ultimately the DAPT regimen is up to the discretion of the treating physician. This is a post-hoc, pooled analysis.  
  11. Généreux P, et al. Circ Cardiovasc Interv. 2015;8:e001362. doi:10.1161/CIRCINTERVENTIONS.114.001362. 

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