A very short duration of dual-antiplatelet therapy following percutaneous coronary intervention: a meta-analysis of randomized clinical trials

Background Dual-antiplatelet therapy (DAPT) is recommended after percutaneous coronary intervention (PCI) to reduce recurrent ischemic events, though optimal duration is unclear. Recent randomized controlled trials (RCTs) have compared shorter durations of DAPT following PCI to the 6- or 12-month regimen for stable coronary artery disease and acute coronary syndrome, respectively, recommend by both European and US guidelines. These RCTs have suggested shorter durations of DAPT may be non-inferior to traditional regimens with respect to ischemic outcomes, while reducing the risk of bleeding. It is not clear if a 3-month or less-than-three month duration of DAPT following PCI has an impact on clinical outcomes. Purpose To determine if a short or "very short" durations of DAPT following PCI has an impact on clinical outcomes. 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. Subgroups were analyzed based on whether the RCT included short DAPT (3 months) or "very short" DAPT (< 3 months) in comparison to traditional DAPT duration. Results Ten studies met inclusion criteria, reporting results on 43,846 patients, of whom 18,582 (72.6% male; aged 62.8 years; 53.8% with ACS) in short DAPT studies, and 25,264 (77.1% male; aged 63.9 years; 58.9% with ACS) in very short DAPT studies. Two studies, both in the 3-month duration cohort, followed DAPT with aspirin monotherapy, the eight others used P2Y12 inhibitors. Of studies included in the very short subgroup, duration of DAPT varied between <1 month to 2 months. Follow-up ranged from 12 to 24 months. Shorter duration of DAPT resulted in decreased rates of significant bleeding compared to traditional DAPT duration (RR: 0.55; [0.39, 0.75], p<0.001) across all studies. Subgroup analysis demonstrated no difference in rates of bleeding between the short and very short DAPT duration cohorts. There was no statistically significant differences in clinical outcomes between the short DAPT and very short DAPT cohorts with respects to the other clinical outcomes such as mortality, cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, and target vessel revascularization. Conclusion Both short (3 month) duration and very short (<3 month) duration of DAPT following PCI are associated with decreased rates of bleeding events compared to traditional durations of DAPT, without significant impact on other clinical outcomes. There is no significant difference between short DAPT and very short DAPT on any of the measured clinical outcomes.