Key result
Short-term DAPT followed by P2Y12 monotherapy cuts NACE ~20% vs. standard DAPT in ACS post-PCI.
Why the study?
The optimal duration of DAPT after PCI in ACS remains debated, balancing ischemic prevention against increased bleeding risk.
Does short-term DAPT followed by P2Y12 inhibitor monotherapy reduce adverse clinical events and bleeding compared to standard-duration DAPT in ACS patients undergoing PCI?
Meta-Analysis (n=35,277)
Does short-term DAPT followed by P2Y12 inhibitor monotherapy reduce adverse clinical events and bleeding compared to standard-duration DAPT in ACS patients undergoing PCI?
Effect estimate: RR 0.80 (95% CI 0.71-0.90)
p-value: p=0.0002
Early transition to P2Y12 inhibitor monotherapy after 1-3 months of DAPT in ACS patients undergoing PCI significantly reduces major bleeding without increasing the risk of ischemic events compared to standard 12-month DAPT.
Supports early P2Y12 monotherapy after short DAPT in ACS-PCI; reinforces consensus for net clinical benefit.
Background The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) remains debated. While DAPT with aspirin and a P2Y12 inhibitor prevents ischemic events, it increases bleeding risk. This meta-analysis evaluates whether early aspirin discontinuation with P2Y12 inhibitor monotherapy offers comparable efficacy and improved safety versus standard long-term DAPT. Methods This review, conducted according to PRISMA guidelines, searched PubMed, Cochrane Central and Clinicaltrials.gov up to September 2025 for RCTs comparing short-term DAPT (≤3 months) followed by P2Y12 inhibitor monotherapy with standard-duration DAPT (≥6-12 months). Outcomes included NACE, MACE, all-cause and cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, and BARC 3 or 5 bleeding. Random-effects models were applied to estimate pooled risk ratios and 95% CIs. Results Ten RCTs involving 35,277 patients were included. Compared with standard DAPT, short-term DAPT followed by P2Y12 inhibitor monotherapy significantly reduced NACE (RR = 0.80, 95% CI 0.71-0.90; p = 0.0002; I 2 = 38%), and BARC type 3 or 5 bleeding (RR = 0.48, 95% CI 0.40-0.58; p < 0.001; I 2 = 0%), without significant differences in MACE (RR: 1.01 [0.86, 1.19]; p = 0.87; I 2 = 41%) or all-cause mortality (RR: 0.96 [0.80, 1.16]; p = 0.69; I 2 = 4%). Conclusion Early transition to P2Y12 inhibitor monotherapy after 1–3 months of DAPT in ACS patients undergoing PCI significantly reduces bleeding without increasing ischemic events. Ticagrelor- or prasugrel-based monotherapy represents a safe and effective alternative to conventional 12-month DAPT.
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Ibrahim et al. (2026) conducted a meta-analysis in Acute Coronary Syndromes (n=35,277). Short-term DAPT followed by P2Y12 inhibitor monotherapy vs. Standard-duration DAPT (≥6-12 months) was evaluated on NACE (RR 0.80, 95% CI 0.71-0.90, p=0.0002). Short-term DAPT followed by P2Y12 inhibitor monotherapy significantly reduced NACE (RR 0.80; 95% CI 0.71-0.90; p=0.0002) compared with standard DAPT in ACS patients undergoing PCI.
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