Dual antiplatelet therapy after percutaneous coronary intervention according to bleeding risk (HOST-BR): an open-label, multicentre, randomised clinical trial
Authors' conclusion
In east Asian patients with HBR, 1-month DAPT did not reach non-inferiority to 3-month DAPT for net adverse clinical events. In patients without HBR, 3-month DAPT was non-inferior to 12-month DAPT regarding net adverse clinical events and major adverse cardiac or cerebral events, and superior for bleeding.
Study context
- Population
- Patients aged ≥19 years after PCI with drug-eluting stent at 50 centres in South Korea, stratified by ARC high bleeding risk1,598 high bleeding risk (HBR), 3299 non-HBR
- Participants
- 4,897 patients
- Comparison
- Shorter vs longer DAPT after PCI, by bleeding risk stratum
- HBR 1-month DAPTn = 798
- HBR 3-month DAPTn = 800reference
- Non-HBR 3-month DAPTn = 1,649
- Non-HBR 12-month DAPTn = 1,650reference
- Primary endpoint
- Three coprimary endpoints, hierarchical: net adverse clinical events (all-cause death, MI, stent thrombosis, stroke or major bleeding); MACCE (CV death, MI, definite or probable stent thrombosis or ischaemic stroke); any actionable non-surgical bleeding
- Follow-up
- 1 year after randomisation
Methodological detailsopen-label, multicentre, non-inferiority, stratified by bleeding risk
- Open-label
- Multicentre
- Non-inferiority
- Stratified by bleeding risk
Primary result
As reported in the abstract
Coprimary endpoints · 1 year
HBR 1-month DAPT
- Net adverse clinical events
- 144 [18.4%]
- MACCE
- 74 (9.8%)
- Bleeding
- 105 (13.8%)
HBR 3-month DAPT
- Net adverse clinical events
- 110 [14.0%]
- MACCE
- 44 (5.8%)
- Bleeding
- 122 (15.8%)
Non-HBR 3-month DAPT
- Net adverse clinical events
- 47 [2.9%]
- MACCE
- 36 [2.2%]
- Bleeding
- 120 [7.4%]
Non-HBR 12-month DAPT
- Net adverse clinical events
- 72 [4.4%]
- MACCE
- 37 [2.3%]
- Bleeding
- 190 [11.7%]
Net adverse clinical events
HBR 1-month DAPT144 [18.4%]
HBR 3-month DAPT110 [14.0%]
Non-HBR 3-month DAPT47 [2.9%]
Non-HBR 12-month DAPT72 [4.4%]
MACCE
HBR 1-month DAPT74 (9.8%)
HBR 3-month DAPT44 (5.8%)
Non-HBR 3-month DAPT36 [2.2%]
Non-HBR 12-month DAPT37 [2.3%]
Bleeding
HBR 1-month DAPT105 (13.8%)
HBR 3-month DAPT122 (15.8%)
Non-HBR 3-month DAPT120 [7.4%]
Non-HBR 12-month DAPT190 [11.7%]
Hazard ratio (95% CI)P value
HBR 1-month DAPT vs HBR 3-month DAPTnet adverse clinical events; non-inferiority not reached
1.337(1.043–1.713)
P = 0.82 for non-inferiorityNon-HBR 3-month DAPT vs Non-HBR 12-month DAPTnet adverse clinical events; non-inferior
0.657(0.455–0.949)
P < 0.0001 for non-inferiorityNon-HBR 3-month DAPT vs Non-HBR 12-month DAPTMACCE; non-inferior
0.984(0.622–1.558)
P = 0.0082 for non-inferiorityNon-HBR 3-month DAPT vs Non-HBR 12-month DAPTbleeding; superior
0.631(0.502–0.793)
P < 0.0001Safety
| Outcome | HBR 1-month DAPT | HBR 3-month DAPT | Non-HBR 3-month DAPT | Non-HBR 12-month DAPT | HR (95% CI) | P value | |
|---|---|---|---|---|---|---|---|
| Any actionable non-surgical bleeding (coprimary) · 1 year | 13.8% | 15.8% | 7.4% | 11.7% | 0.631 (0.502–0.793) | P < 0.0001 | |
| 0.512Hazard ratio (log scale) |
Original publication
Dual antiplatelet therapy after percutaneous coronary intervention according to bleeding risk (HOST-BR): an open-label, multicentre, randomised clinical trial. Lancet. Published 23 October 2025. doi:10.
Summarised from the published abstract; every number is checked against it