Baseline Anemia and Short Dual Antiplatelet Therapy in High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention.

Aims In patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI), abbreviated dual antiplatelet therapy (DAPT) has been shown to reduce bleeding without increasing ischemic risk. However, the optimal duration in specific subgroups, particularly anemic patients, remains unclear and was the focus of this analysis.Methods This study included 3,364 HBR patients from three prospective trials in the XIENCE Short DAPT Program who underwent PCI with cobalt-chromium everolimus-eluting stents. Anemia was defined as Hb <11 g/dL. The primary endpoint was all-cause death or myocardial infarction; secondary endpoints included BARC 2-5 and 3-5 bleeding. Outcomes by DAPT duration (1 vs 3 months), defined according to study protocol, were assessed using propensity score stratification.Results Anemia was present in 514 patients (15.3%). At 1 year, anemic patients experienced higher rates of both ischemic and bleeding events compared with non-anemic patients. Among anemic patients, ischemic outcomes were similar with 1- and 3-month DAPT (15.7% vs 16.3%; adjusted hazard ratio [adjHR] 0.94, 95% confidence interval [CI] 0.59-1.52; p=0.807), whereas 1-month DAPT was associated with a lower incidence of major bleeding (6.1% vs 11.1%; adjHR 0.49, 95% CI 0.24-1.00; p=0.050). In non-anemic patients, ischemic and bleeding outcomes were similar irrespective of DAPT duration.Conclusions Among HBR patients undergoing PCI, abbreviated DAPT was associated with comparable ischemic outcomes regardless of anemia status. In patients with baseline anemia, 1-month DAPT was associated with lower major bleeding without an apparent ischemic trade-off.This study evaluated whether shortening DAPT to 1 month, compared with 3 months, is safe and effective in HBR patients undergoing PCI, with a specific focus on those with baseline anemia—a subgroup known to be particularly vulnerable to both ischemic and bleeding complications. Key findings: Baseline anemia identified a high-risk phenotype associated with increased rates of both ischemic and bleeding events at 1 year.Shortening DAPT to 1 month did not increase the risk of ischemic events compared with 3-month DAPT, regardless of anemia status.In patients with baseline anemia, 1-month DAPT reduced major bleeding compared with 3-month DAPT, without an apparent ischemic trade-off. Clinical implications: These findings support a more individualized approach to antiplatelet therapy after PCI. In patients with baseline anemia, abbreviated DAPT may represent a reasonable strategy to mitigate bleeding risk without compromising ischemic protection, although results should be interpreted with caution and confirmed in randomized studies.