ESC 23 — Dr Masahiro Natsuaki (Saga University, JP) discusses the short and optimal duration of dual antiplatelet therapy-3 Study (STOPDAPT-3) (NCT04609111). 

In the STOPDAPT-2 study, 1-month dual antiplatelet therapy (DAPT) followed by clopidogrel monotherapy was shown to provide benefits in bleeding reduction over a 12-month period, however, other trials have shown high rates of bleeding at one year in high bleeding risk (HBR) patients. The STOPDAPT-3 Study (Kyoto University) aimed to explore the potential benefits of prasugrel monotherapy (without aspirin) when compared with 1-month of DAPT with aspirin and prasugrel in reducing bleeding events post-percutaneous coronary intervention (PCI) in HBR and acute coronary syndrome (ACS) patients. 

6002 patients were enrolled in the trial, where major bleeding was defined as BARC criteria 3 or 5. Results suggested that prasugrel monotherapy did not attest superiority for the reduction of major bleeding events within 1 month after PCI, and was associated with an excess of coronary events including sub-acute stent thrombosis.

Questions:

1. What is the background to this trial?
2. 2. What was the study design, patient population and outcome measures?
3. What are the key results presented at ESC?
4. What is the applicability to populations outside of Japan?
5. What are the take-home messages?
6. What are the next steps?

Recorded on-site at ESC Congress 2023, Amsterdam. 

Editors: Mirjam Boros and Jordan Rance

Video Specialists: Dan Brent, Tom Green, Mike Knight, Oliver Miles