1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful Percutaneous Coronary Intervention

1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful Percutaneous Coronary InterventionDrugs Aging . 2025 Oct;42(10):975-985. doi:10.1007/s40266-025-01235-z. AbstractPurpose: Compared with long-term dual antiplatelet therapy (DAPT, aspirin with clopidogrel or ticagrelor), short-termDAPT followed by single antiplatelet therapy (SAPT, clopidogrel or ticagrelor) has demonstrated superiority in reducing bleeding risk while maintaining non-inferior in cardiovascular benefits in coronary heart disease (CHD) aftersuccessful percutaneous coronary intervention (PCI). However, no prospective study has explored the benefits of this short-term regimen on patients with chronic total occlusion (CTO) undergoing PCI.Methods: Consecutive patients who underwentsuccessful elective CTO-PCI were prospectively enrolled from April 2019 to May 2021. After receiving 1-month DAPT, all patients were divided into two groups: SAPT group (followed by clopidogrel or ticagrelor monotherapy) and DAPT group(continued with dual antiplatelet therapy). Detailed baseline characteristics, angiographic and procedural details, and 1-year follow-up data were collected. The endpoints were major adverse cardiovascular events (MACE) and bleeding.Results: A total of 701 patients who underwentsuccessful CTO-PCI were enrolled, among whom 330 patients (47.1%) received DAPT and 371 patients (52.9%) received SAPT (clopidogrel or ticagrelor) after 1-month DAPT. Compared with patients receiving DAPT, patients in the SAPT (clopidogrel or ticagrelor) group had a lower rate of previous stroke, fewerleft anterior descending coronary artery (LAD) lesions and contrast volume, and fewer lesions per patient, but longer lesion length (P < 0.05). The incidence of major adverse cardiovascular events (14.5% versus 15.4%; p = 0.742) was not significantly different between the two groups. The DAPT group showed a higher incidence of minor bleeding (BARC types 1 or 2; 12.7% versus 2.3%, p < 0.001) than SAPT (clopidogrel or ticagrelor), while no difference was found for major bleeding (BARC types 3 or 5; 1.2% versus 2.3%, p = 0.261).Conclusions: Compared with standard 12-month dualantiplatelet therapy, 1-month dual antiplatelet therapy followed by clopidogrel or ticagrelor monotherapy resulted in lower bleeding risks and similar cardiovascular benefits in chronic total occlusion - percutaneous coronary intervention patients.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.