Shorter DAPT (<3 months) post-PCI reduces significant bleeding by 45% in East Asian patients (RR 0.45, p<0.001), with no increase in ischemic events.
Does a shorter duration of dual-antiplatelet therapy (<3 months) reduce significant bleeding compared to traditional durations in patients following percutaneous coronary intervention?
Shorter duration of dual-antiplatelet therapy (<3 months) following PCI significantly reduces bleeding events compared to traditional durations, with patients of East Asian ancestry potentially deriving an outsized benefit.
Absolute Event Rate: 0% vs 0%
Abstract Background Dual-antiplatelet therapy (DAPT) is recommended after percutaneous coronary intervention (PCI) to reduce recurrent ischemic events, though the optimal duration is unclear. Recent randomized controlled trials (RCTs) have compared shorter durations of DAPT following PCI to the traditional 6- or 12-month regimen for stable coronary artery disease and acute coronary syndrome, respectively, that is recommend by both European and American guidelines. Patients of East Asian-descent have been shown to have increased risks of bleeding, especially those taking anti platelet agents following ACS, which may affect the clinical outcomes of these studies. Purpose To determine whether East Asian-ethnicity impacts 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. Outcomes of interest include 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. Subgroup analysis by East-Asian status was performed. Results Ten studies met inclusion criteria, reporting results on 43,882 patients, of whom 18,812 were in the East Asian cohort and 24,547 were in the non-East Asian cohort. Duration of DAPT ranged from 1-3 months. 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. Seven studies took place predominately in East Asia, whereas three studies took place elsewhere, most commonly European countries. Shorter duration of DAPT resulted in decreased rates of significant bleeding compared to traditional DAPT duration (RR: 0.55; 0.39, 0.75, p0.001) across all studies. When analyzed by subgroup, the East Asia-predominant studies was statistically significant for decreased rates of bleeding (RR: 0.45; 0.34, 0.59, p0.001), whereas the non-East Asia studies did not meet statistical significance (RR: 0.74; 0.48, 1.15, p=0.18). There was otherwise no statistically significant differences in clinical outcomes between the East Asian and non-East Asian cohorts with respects to the other clinical outcomes such as mortality, cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, and target vessel revascularization. Conclusion Shorter duration of DAPT following PCI results in decreased rates of bleeding events compared to traditional durations of DAPT. Patients of East Asian ancestry may experience an outsized benefit with respect to bleeding outcomes compared to their non-East Asian counterparts. Future studies are necessary to confirm these findings.
Fretz et al. (Sat,) reported a other. Shorter DAPT (<3 months) post-PCI reduces significant bleeding by 45% in East Asian patients (RR 0.45, p<0.001), with no increase in ischemic events.