The optimal duration of dual antiplatelet therapy (DAPT) in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) has remained uncertain. A large analysis from the MASTER DAPT (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Standard DAPT Regimen) trial, published in the Journal of the American College of Cardiology, assessed the effect of abbreviated versus prolonged DAPT on total clinical events.

The study included 4,579 HBR patients randomized to an abbreviated regimen (median 34 days) or a prolonged regimen (median 192 days). Coprimary outcomes at 335 days were net adverse clinical events (NACEs: all-cause death, myocardial infarction, stroke, or BARC type 3 or 5 bleeding), major adverse cardiac and cerebral events (MACCEs: all-cause death, myocardial infarction, or stroke), and major or clinically relevant nonmajor bleeding (MCB: BARC type 2, 3, or 5).

Abbreviated DAPT showed no significant difference in NACEs (HR 0.95; P=0.64) or MACCEs (HR 0.96; P=0.69) compared with prolonged therapy, but significantly reduced bleeding (HR 0.78; P=0.011). It also lowered the risk of cerebrovascular accidents (HR 0.51; P=0.023) and stroke (HR 0.49; P=0.04). These findings highlight that a one-month DAPT strategy maintains ischemic protection while lowering bleeding burden in HBR patients after PCI.