Short-term dual-antiplatelet therapy (<3 months) following PCI significantly reduced significant bleeding compared to traditional durations (RR 0.55; 95% CI 0.39-0.75; p<0.001).
Meta-Analysis (n=43,882)
Does a shorter duration of dual-antiplatelet therapy (<3 months) reduce bleeding without increasing ischemic events in patients following percutaneous coronary intervention?
A short duration of dual-antiplatelet therapy (<3 months) after PCI significantly reduces bleeding risk without increasing the risk of ischemic events compared to traditional guideline-recommended durations.
Effect estimate: RR 0.55 (95% CI 0.39-0.75)
p-value: p=<0.001
Abstract Background Dual-antiplatelet therapy (DAPT) is recommended after percutaneous coronary intervention (PCI) to reduce recurrent ischemic events, though the optimal duration is unclear. Anti platelet therapies reduce recurrent ischemic events, though this comes at the cost of increased risk of bleeding. Currently, both European and American guidelines recommend a 6-month duration of DAPT following PCI for stable coronary disease and a 12-month regimen following PCI for acute coronary syndrome. Recent randomized clinical trials (RCTs) suggest a shorter duration of DAPT may be acceptable. Purpose To determine the clinical impacts of shorter duration of DAPT following PCI. Methods PubMed, EMBASE, and Cochrane databases were queried from inception to February 2025 to identify RCTs comparing short-term (3 months) with traditional durations of DAPT following PCI reporting outcomes of interest including mortality, cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, significant bleeding, and target vessel revascularization. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) for dichotomous outcomes with 95% confidence intervals. Results Ten studies met inclusion criteria, reporting results on 43,882 patients (21,663 in the short DAPT group and 21,696 in the control group). Duration of DAPT ranged from 1-3 months. Seven studies used P2Y12 inhibitors as the single-platelet agent following DAPT, whereas three studies used aspirin. Patients were 75.2% male, mean age 64.0 ± 10.7 years, and 56.8% presented with ACS. Follow up ranged from 12 to 24 months. Shorter duration of DAPT resulted in decreased rates of significant bleeding (RR: 0.55; 0.39, 0.75, p0.001). There was no impact of shorter duration of DAPT on other clinical outcomes such as mortality, cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, and target vessel revascularization. Complete results are shown in the figure. Conclusion Shorter duration (3 months) of DAPT following PCI resulted in decreased rates of significant bleeding, without impacting other clinical outcomes such as mortality, myocardial infarction, stroke, stent thrombosis, and target vessel revascularization compared to guideline-recommended lengths of DAPT.
Fretz et al. (Sat,) conducted a meta-analysis in Percutaneous coronary intervention (PCI) (n=43,882). Short-term dual-antiplatelet therapy (DAPT) vs. Traditional guideline-recommended durations of DAPT was evaluated on Significant bleeding (RR 0.55, 95% CI 0.39-0.75, p=<0.001). Short-term dual-antiplatelet therapy (<3 months) following PCI significantly reduced significant bleeding compared to traditional durations (RR 0.55; 95% CI 0.39-0.75; p<0.001).