Key result
Single antiplatelet therapy or shortened DAPT showed no significant difference in MACE compared to standard DAPT, while SAPT significantly reduced the risk of major bleeding in ACS patients.
Why the study?
Standard 12-month DAPT with aspirin and a potent P2Y12 inhibitor causes frequent hemorrhagic complications, prompting numerous studies of simplified or shortened DAPT regimens that required comprehensive evaluation.
Do simplified or shortened antiplatelet regimens reduce bleeding without increasing MACE in patients with ACS compared to standard 12-month DAPT?
Meta-Analysis (n=63,009)
Do simplified or shortened antiplatelet regimens reduce bleeding without increasing MACE in patients with ACS compared to standard 12-month DAPT?
Simplified antiplatelet regimens, such as single antiplatelet therapy or shortened DAPT, reduce major bleeding without increasing MACE in ACS patients compared to standard 12-month DAPT, though clopidogrel-based strategies may increase ischemic risks.
Introduction The latest European Guidelines for the management of acute coronary syndromes (ACS) recommends double antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor (ticagrelor or prasugrel) for the first 12 months. However, haemorrhagic complications are frequent. Consequently, numerous recent studies have compared new simplified or shortened DAPT with usual care. Objective The principal aim of this study is to analyze the major adverse cardiovascular (MACE) and bleeding events in patients with ACS, grouping patients based on the therapy received. As a secondary outcome, we studied the incidence of stent thrombosis and myocardial infarction. Methods A network metanalysis with a frequentist approach of randomized effects was carried out, including 16 randomized controlled trial (RCT) that compared the different strategies. All inconsistency test performed for each comparison showed no significance, indicating consistency. Results A total of 63009 patients were included. In the network plot, the general representation of the different strategies and their direct comparisons are shown. Mostly, RCTs compared DAPT with a potent P2Y12 inhibitor (Standard DAPT) and DAPT with clopidogrel both for 12 months. Regarding the league table, the information of all the comparations is exhibited. A statistically significant reduction in the risk of major bleeding was observed with clopidogrel and ticagrelor in monotherapy compared to the standard DAPT strategy, Prasugrel 5mgr DAPT and Clopidogrel DAPT. Additionally, this reduction was seen with clopidogrel in monotherapy compared to DAPT with prasugrel 5mg. No statistical differences appeared in terms of MACE between all the therapeutic approaches. In terms of stent thrombosis, ticagrelor in monotherapy and standard DAPT showed a statistically significant reduction of events compared to clopidogrel in monotherapy and clopidogrel DAPT, as well as ticagrelor in monotherapy compared to 6-month clopidogrel DAPT. This reduction also appeared when comparing the group of de-escalation DAPT to clopidogrel in monotherapy. Finally, clopidogrel exhibited a statistically significant increase of myocardial infarction compared to all groups except the 6-month clopidogrel DAPT, while the de-escalation DAPT group revealed a statistically significant reduction compared to the 6-month Clopidogrel DAPT. Conclusion The therapeutic approach with either single antiplatelet therapy (SAPT) or shortened DAPT in patients who suffered an ACS appeared to be safe, with no differences in terms of MACE. Additionally, a statistically significant reduction in the risk of major bleeding was observed with SAPT. However, strategies involving clopidogrel showed a higher predisposition to myocardial infarction and stent thrombosis. This opens a new perspective for future research on whether aspirin should be administered systematically in ACS or if low-risk bleeding strategies, such as DAPT with clopidogrel, should be avoided.
No takes yet. Share an insight, caveat, or question.
Del-Cuerpo-Salinas et al. (2025) conducted a meta-analysis in Acute coronary syndromes (ACS) (n=63,009). Simplified or shortened DAPT and single antiplatelet therapy (SAPT) vs. Standard DAPT (aspirin and potent P2Y12 inhibitor for 12 months) was evaluated on Major adverse cardiovascular events (MACE) and bleeding events. Single antiplatelet therapy or shortened DAPT showed no significant difference in MACE compared to standard DAPT, while SAPT significantly reduced the risk of major bleeding in ACS patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: