COBRA-REDUCE randomized 996 patients undergoing PCI for acute or chronic coronary syndromes who were receiving oral anticoagulation, to undergo stenting with a thromboresistant polyzene F-coated stent (Cobra) with 14 day duration DAPT (P2Y12 was stopped) versus DES with 3-6-month duration of DAPT. The study did not meet the non-inferiority criteria with respect to thombotic events as compared to the DES arm and did not show a reduction in BARC 2-5 bleeding after 14 days. The DES group did have significantly more patients with OAC dose reduction during the follow-up period (56% of patients vs. 46% of patients in the Cobra group). Overall. The results of the trial were surprising as shorter DAPT duration has been shown in some trials to reduce bleeding risk. These results suggest that anticoagulants seem to be the driver of bleeding risk more so than clopidogrel in the patient population studied.
All Editors: David A. Cox, MD, MSCAI, Allison G. Dupont, MD, FSCAI, Kirk N. Garratt, MD, MSc, MSCAI, Cindy L. Grines, MD, MSCAI, Andrew J. Klein, MD, FSCAI, and Jordan Safirstein, MD, FSCAI.
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