Prof. Marco Valgimigli presented at the ESC congress – and simultaneously published in the New England Journal of Medicine – the results of a study that defines a new “standard of care” and will soon provide the scientific basis for new international guidelines in the management of antiplatelet therapy after stent implantation in patients at high bleeding risk.

The trial ((MAnagement of high bleeding risk patients post bioresorbable polymer coated STEnt implantation with an abbReviated versus prolonged DAPT regimen – MASTER DAPT) was designed years ago by Prof. Valgimigli in collaboration with other academics and was funded by a non-profit institute based in the Netherlands. 140 centres were involved – in Europe, Asia, South America and Australia – and more than 4500 patients: in fact the largest study ever conducted on this subject.

The study focused on a particular population of patients who require coronary angioplasty with stent implantation but who have one or more risk factors for bleeding. Until recently, these patients were prescribed a dual antiplatelet agent for at least a year; then a series of studies suggested the trade-off between benefits and risks of 1 year dual antiplatelet therapy was not favorable to patients, which led to new recommendations that the treatment should be shorter than 1 year. Today – or rather until the presentation of the results of our study – the guidelines set a time horizon of 3-6 months for therapy.

The Master-DAPT study went further, comparing the international guidelines with a duration of just one month, and showed that in the latter case there is no penalty from the point of view of effectiveness, but at the same time there is a reduction in the risk of bleeding.

We have gone in a very short time,” notes Prof. Valgimigli, “from a situation in which the patient was told that he would have to take a therapy for a long or very long period of time that would have a serious impact on his quality of life (in addition to side effects, antiplatelet therapy increases the complexity and risk in the event of surgery) to a prospect that is firmly more manageable and that the patient can face with much more serenity. An important step.