Short-term DAPT followed by P2Y12 inhibitor monotherapy significantly reduced NACE (RR 0.80; 95% CI 0.71-0.90; p=0.0002) compared with standard DAPT in ACS patients undergoing PCI.
Meta-Analysis (n=35,277)
Does short-term DAPT followed by P2Y12 inhibitor monotherapy reduce adverse clinical events and bleeding compared to standard-duration DAPT in ACS patients undergoing PCI?
Early transition to P2Y12 inhibitor monotherapy after 1-3 months of DAPT in ACS patients undergoing PCI significantly reduces major bleeding without increasing the risk of ischemic events compared to standard 12-month DAPT.
Estimación del efecto: RR 0.80 (95% CI 0.71-0.90)
valor p: p=0.0002
Background The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) remains debated. While DAPT with aspirin and a P2Y12 inhibitor prevents ischemic events, it increases bleeding risk. This meta-analysis evaluates whether early aspirin discontinuation with P2Y12 inhibitor monotherapy offers comparable efficacy and improved safety versus standard long-term DAPT. Methods This review, conducted according to PRISMA guidelines, searched PubMed, Cochrane Central and Clinicaltrials.gov up to September 2025 for RCTs comparing short-term DAPT (≤3 months) followed by P2Y12 inhibitor monotherapy with standard-duration DAPT (≥6-12 months). Outcomes included NACE, MACE, all-cause and cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, and BARC 3 or 5 bleeding. Random-effects models were applied to estimate pooled risk ratios and 95% CIs. Results Ten RCTs involving 35,277 patients were included. Compared with standard DAPT, short-term DAPT followed by P2Y12 inhibitor monotherapy significantly reduced NACE (RR = 0.80, 95% CI 0.71-0.90; p = 0.0002; I 2 = 38%), and BARC type 3 or 5 bleeding (RR = 0.48, 95% CI 0.40-0.58; p < 0.001; I 2 = 0%), without significant differences in MACE (RR: 1.01 0.86, 1.19; p = 0.87; I 2 = 41%) or all-cause mortality (RR: 0.96 0.80, 1.16; p = 0.69; I 2 = 4%). Conclusion Early transition to P2Y12 inhibitor monotherapy after 1–3 months of DAPT in ACS patients undergoing PCI significantly reduces bleeding without increasing ischemic events. Ticagrelor- or prasugrel-based monotherapy represents a safe and effective alternative to conventional 12-month DAPT.
Ibrahim et al. (Thu,) conducted a meta-analysis in Acute Coronary Syndromes (n=35,277). Short-term DAPT followed by P2Y12 inhibitor monotherapy vs. Standard-duration DAPT (≥6-12 months) was evaluated on NACE (RR 0.80, 95% CI 0.71-0.90, p=0.0002). Short-term DAPT followed by P2Y12 inhibitor monotherapy significantly reduced NACE (RR 0.80; 95% CI 0.71-0.90; p=0.0002) compared with standard DAPT in ACS patients undergoing PCI.
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