The Impact of Dual Antiplatelet Therapy on Bleeding and Thrombotic Risks in Diabetic Patients Following Coronary Stent Implantation: A Prospective Study.

Aims

To evaluate the 12-month clinical outcomes of short-term versus extended dual antiplatelet therapy (DAPT) in diabetic patients following drug-eluting stent (DES) implantation.

Methods

In this single-center prospective cohort study, 536 diabetic patients undergoing DES implantation were categorized into short-term (< 6 months, n = 312) or extended (≥ 6 months, n = 224) DAPT groups based on actual treatment duration. Primary endpoints were major adverse cardiovascular events (MACE: cardiac death, myocardial infarction, and target vessel revascularization) and BARC type 2, 3, or 5 bleeding events at 12 months.

Results

Extended DAPT significantly reduced the incidence of MACE compared to short-term therapy (7.8% vs. 10.5%; HR = 0.72, 95% CI: 0.53-0.98, p = 0.033), primarily driven by lower rates of target vessel revascularization (3.1% vs. 5.1%; p = 0.030). While overall bleeding rates did not differ significantly between groups (8.1% vs. 6.2%; p = 0.192), extended DAPT was associated with a significantly higher risk of recurrent bleeding in patients with a prior bleeding history (HR = 2.10, 95% CI: 1.20-3.60, p = 0.011).

Conclusion

Extended DAPT effectively mitigates ischemic risks in diabetic patients following stent implantation without significantly increasing overall clinically significant bleeding. However, clinicians should prioritize individualized DAPT durations, specifically avoiding extended regimens in patients with a history of bleeding to minimize the risk of hemorrhage recurrence.