In patients with ACS undergoing PCI, shorter DAPT duration (<3 months) significantly decreased significant bleeding compared to traditional DAPT (RR 0.52; 95% CI 0.42-0.64; p<0.001).
Meta-Analysis (n=29,345)
Does a shorter duration of DAPT (<3 months) reduce bleeding without increasing ischemic events compared to traditional DAPT duration in patients with ACS undergoing PCI?
In patients with ACS undergoing PCI, a short DAPT strategy (<3 months) significantly reduces bleeding without increasing the risk of mortality or ischemic events compared to traditional 12-month DAPT.
Relative Risk: 0.52 (95% CI 0.42–0.64)
p-value: p=<0.001
Abstract Background Dual-antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is recommended after percutaneous coronary intervention (PCI) to reduce recurrent ischemic events, though the optimal duration is unclear. Though DAPT reduces ischemic events following PCI, the risk of bleeding is substantially increased. Both European and US guidelines suggest a 12-month duration of DAPT following acute coronary syndrome (ACS). Recent randomized controlled trials (RCTs) exploring DAPT duration following PCI suggest that a shorter duration of DAPT may be acceptable. It is not apparent the impact of shorter durations of DAPT have on clinical outcomes in patients presenting with ACS. Purpose To determine the clinical impacts of shorter DAPT duration following PCI in patients presenting with ACS. 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 for ACS. Outcomes of interest include mortality, cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, significant bleeding, and target vessel revascularization. We defined significant bleeding as Bleeding Academic Research Consortium (BARC) types 3 or 5 when this information was available. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) for dichotomous outcomes with 95% confidence intervals. Results Nine studies met inclusion criteria and reported results on 29,345 patients with ACS, of whom 14,637 were in the short DAPT cohort and 14,708 were in the control cohort. Patients were 72.1% male, mean age 63.3 years, and 32.8% presented with STEMI. Duration of DAPT ranged from 1-3 months and was followed by P2Y12 monotherapy in seven studies, aspirin monotherapy in two studies. Follow-up ranged from 12-24 months. Shorter DAPT duration resulted in decreased rates of significant bleeding events compared to traditional DAPT duration (RR: 0.52; 0.42, 0.64, p0.001). There is a trend toward decreased stent thrombosis in favor of traditional DAPT duration, though this did not reach statistical significance (RR: 1.18; 0.83, 1.69, p=0.36). There was otherwise no impact of shorter duration of DAPT on other clinical outcomes such as mortality, cardiovascular mortality, myocardial infarction, stroke, and target vessel revascularization. Conclusion In patients presenting with ACS, shorter duration of DAPT following PCI is associated with significantly decreased rates of bleeding events compared to traditional duration of DAPT. Other clinical outcomes such as mortality, myocardial infarction, stroke, and target vessel revascularization were not significantly affected.
Dasari et al. (Sat,) conducted a meta-analysis in Acute coronary syndrome following percutaneous coronary intervention (n=29,345). Short-term dual-antiplatelet therapy (DAPT) vs. Traditional duration of DAPT was evaluated on Significant bleeding (BARC types 3 or 5) (RR 0.52, 95% CI 0.42, 0.64, p=<0.001). In patients with ACS undergoing PCI, shorter DAPT duration (<3 months) significantly decreased significant bleeding compared to traditional DAPT (RR 0.52; 95% CI 0.42-0.64; p<0.001).