Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk

This multicenter randomized trial (MASTER DAPT) evaluated abbreviated vs. standard-duration dual antiplatelet therapy (DAPT) in 4579 patients with high bleeding risk following implantation of biodegradable-polymer sirolimus-eluting stents. One month post–PCI, patients were assigned to either stop DAPT and continue single antiplatelet therapy (abbreviated group) or extend DAPT for ≥2 more months (standard group). Over 335 days, abbreviated DAPT was noninferior to standard DAPT for both net adverse clinical events (7.5% vs. 7.7%) and major cardiac/cerebral events (6.1% vs. 5.9%). Major or clinically relevant nonmajor bleeding was significantly reduced in the abbreviated group (6.5% vs. 9.4%; HR 0.68; P<0.001). Subgroup analyses affirmed consistent outcomes, and procedural, medication, and comorbidity profiles were balanced across groups. The trial supports one-month DAPT as an effective bleeding-sparing strategy in high-risk patients after PCI.

This multicenter randomized trial (MASTER DAPT) evaluated abbreviated vs. standard-duration dual antiplatelet therapy (DAPT) in 4579 patients with high bleeding risk following implantation of biodegradable-polymer sirolimus-eluting stents. One month post–PCI, patients were assigned to either stop DAPT and continue single antiplatelet therapy (abbreviated group) or extend DAPT for ≥2 more months (standard group). Over 335 days, abbreviated DAPT was noninferior to standard DAPT for both net adverse clinical events (7.5% vs. 7.7%) and major cardiac/cerebral events (6.1% vs. 5.9%). Major or clinically relevant nonmajor bleeding was significantly reduced in the abbreviated group (6.5% vs. 9.4%; HR 0.68; P<0.001). Subgroup analyses affirmed consistent outcomes, and procedural, medication, and comorbidity profiles were balanced across groups. The trial supports one-month DAPT as an effective bleeding-sparing strategy in high-risk patients after PCI.