Gender should not impact DAPT treatment duration
medwireNews: Gender should not be a primary factor when deciding the duration of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), study findings indicate.
Marco Valgimigli (Bern University Hospital, Switzerland) and co-researchers found that men and women undergoing PCI had similar rates of death, myocardial infarction (MI) or cerebrovascular accident (CVA), as well as major bleeding, once baseline differences in comorbidity were accounted for. And event rates did not differ according to DAPT duration.
“Sex failed to emerge as a treatment modifier with respect to DAPT duration, suggesting that decision making on DAPT duration in female patients should weigh ischemic versus bleeding risks”, Valgimigli et al remark.
In this subanalysis of PRODIGY data, 140 (9.3%) of the 1511 men and 58 (12.6%) of the 459 women experienced the composite endpoint of death, MI or CVA during 2 years of follow-up.
However, after adjusting for the fact that women were more likely to have hypertension, lower creatinine clearance, acute coronary syndromes and less severe coronary artery disease, there was no significant difference between the two groups, at an adjusted hazard ratio (aHR) of 0.912.
There were also no significant differences between men and women for multiple secondary ischaemic endpoints, including both overall and cardiovascular mortality, MI and stent thrombosis.
For the PRODIGY study, patients were randomly assigned to receive 6 or 24 months of DAPT from 30 days after PCI.
And the current analysis showed that, in line with the initial PRODIGY findings, prolonged DAPT did not reduce the rate of death, MI or CVA in either men (aHR=1.080) or women (aHR=1.013).
Men treated with the prolonged versus short protocol did, however, have a significantly increased risk of Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding that was not observed in women, with respective aHRs of 3.506 and 0.827.
The researchers note that this was primarily driven by an increase in BARC type 2 events in men, and once these were excluded the rate of bleeding did not differ between men and women when treated with DAPT for either 6 or 24 months.
Writing in the Journal of the American College of Cardiology: Cardiovascular Interventions, Valgimigli and team conclude that “the overall results of the PRODIGY trial can be extended with confidence to both sexes.”
By Laura Cowen
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