Extending two-drug antiplatelet therapy pays off after PCI

Clinical takeaway: In stable patients with multivessel coronary artery disease who have completed 12 months of dual antiplatelet therapy after drug-eluting stent implantation without ischemic or bleeding complications, extending clopidogrel plus aspirin for an additional year may further reduce cardiovascular events without an apparent increase in clinically relevant bleeding.

Determining who benefits from prolonged dual antiplatelet therapy remains a challenge. This large randomized trial suggests that selected patients with multivessel coronary artery disease who remain free of ischemic or bleeding events after 1 year may derive additional protection from another year of DAPT.

In the DAPT-MVD trial, investigators randomized 8,250 adults at 97 centers in China who had multivessel coronary artery disease and had remained free of major ischemic or bleeding events during the first year after drug-eluting stent implantation. Patients received either an additional 12 months of clopidogrel plus aspirin or transitioned to aspirin alone, with a median follow-up of 34.3 months.

The primary composite outcome of cardiovascular death, nonfatal MI, or nonfatal stroke occurred in 5.8% of patients receiving extended dual antiplatelet therapy compared with 6.8% of those receiving aspirin alone—an approximately 18% relative reduction in risk. Clinically relevant or major bleeding remained low and was similar between groups (1.4% vs 1.5%).

These findings support consideration of individualized extension of DAPT beyond 12 months in carefully selected, lower-bleeding-risk patients with multivessel coronary disease after PCI, while reinforcing the importance of balancing ischemic benefit against bleeding risk for each patient.

Source: Tian J, et al. (2026 July 15) N Engl J Med. Extended Dual Antiplatelet Therapy for Multivessel Coronary Artery Disease