Sex-Based Differences in the Effect of Short Dual Antiplatelet Therapy Followed by Prasugrel Monotherapy in High-Bleeding-Risk Patients After Percutaneous Coronary Intervention

Background: In patients at high bleeding risk (HBR), short dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) reduces bleeding without increasing ischemic events. However, the sex-based differences in the effects of short DAPT strategy followed by prasugrel monotherapy compared with conventional DAPT strategy remain unclear. Methods and Results: The 24-month outcomes from 2 multicenter, non-interventional, prospective registries, PENDULUM mono (n=872; short DAPT strategy followed by prasugrel monotherapy) and an HBR subset of the PENDULUM registry (n=1,553; conventional DAPT strategy), were analyzed using the inverse probability of treatment weighting method. Primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE) and clinically relevant bleeding (CRB: Bleeding Academic Research Consortium [BARC] types 2, 3, and 5). In women, short DAPT strategy was associated with numerically lower rates of MACCE (8.2% vs. 12.3%; hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.42-1.20; P=0.197) and CRB (4.7% vs. 7.0%; HR 0.68, 95% CI 0.35-1.32; P=0.258). In men, similar trends were observed for MACCE (8.8% vs. 11.0%; HR 0.86, 95% CI 0.62-1.21; P=0.388) and CRB (7.0% vs. 8.1%; HR 0.87, 95% CI 0.60-1.26; P=0.460). No significant interaction between treatment and sex was found for MACCE (P=0.599) or CRB (P=0.537). Conclusions: In HBR patients undergoing PCI, a short DAPT strategy followed by prasugrel monotherapy had numerically fewer ischemic and bleeding events than conventional DAPT strategy, without evidence of sex-based heterogeneity.