Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials
Francesco CostaClaudio MontaltoMattia BrancaSung‐Jin HongHirotoshi WatanabeAnna FranzonePascal VranckxJoo‐Yong HahnHyeon‐Cheol GwonFausto FeresYangsoo JangGiuseppe De LucaElvin KedhiDavide CaoPhilippe Gabríel StegDeepak L. BhattGregg W. StoneAntonio MicariStephan WindeckerTakeshi KimuraMyeong‐Ki HongRoxana MehranMarco Valgimigli
Key result
Abbreviated DAPT duration post-PCI in HBR patients yields no clinical results in the provided abstract.
- RR 0.76
- 95% CI 0.61-0.94
- n=9,006
Why the study?
The optimal duration of dual antiplatelet therapy after PCI in patients at high bleeding risk remains debated.
Does an abbreviated DAPT regimen reduce bleeding and cardiovascular mortality in high bleeding risk patients undergoing PCI?
Key Points
- To evaluate the clinical safety and efficacy of an abbreviated dual antiplatelet therapy regimen compared with standard therapy in patients at high bleeding risk undergoing percutaneous coronary intervention.
- Systematic review and meta-analysis of 11 randomized clinical trials including 9,006 high-bleeding-risk patients without indication for oral anticoagulation (PROSPERO CRD42021284004).
- Compared abbreviated dual antiplatelet therapy regimens (1 or 3 months) against standard regimens (≥6 months).
- Abbreviated therapy significantly reduced major or clinically relevant non-major bleeding (RR: 0.76, 95% CI: 0.61–0.94; I² = 28%) and major bleeding alone (RR: 0.80, 95% CI: 0.64–0.99; I² = 0%).
- Cardiovascular mortality was significantly lower in the abbreviated therapy arm (RR: 0.79, 95% CI: 0.65–0.95; I² = 0%).
- No significant differences occurred in all-cause mortality, major adverse cardiovascular events, myocardial infarction, or stent thrombosis, with consistent results across clinical presentations.
Study Design
Type
Meta-Analysis (n=9,006)
Multicenter
Yes
Structured PICO
Does an abbreviated DAPT regimen reduce bleeding and cardiovascular mortality in high bleeding risk patients undergoing PCI?
P
Population
9,006 high bleeding risk patients without indication for oral anticoagulation undergoing percutaneous coronary intervention from 11 randomized trials.
I
Intervention
Abbreviated dual antiplatelet therapy (DAPT) regimen (very-short [1 month] or short [3 months])
C
Comparator
Standard dual antiplatelet therapy (DAPT) regimen (≥6 months)
O
Outcome
Major or clinically relevant non-major bleeding, major bleeding, and cardiovascular mortalitysafety
Main Result
Relative Risk: 0.76 (95% CI 0.61–0.94)
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“A one-month or 3-month DAPT courses after PCI appears an appealing treatment option in HBR patients to optimize outcomes. Further studies are warranted to determine how to individualize the decision between 1- and 3-month DAPT and the role of single antiplatelet therapy after DAPT.”
Implication
In high bleeding risk patients undergoing PCI, a 1- or 3-month abbreviated DAPT regimen reduces bleeding and cardiovascular mortality without increasing ischemic events compared to a standard ≥6-month regimen.
Abstract
AIMS: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) is still debated. The current study, using the totality of existing evidence, evaluated the impact of an abbreviated DAPT regimen in HBR patients. METHODS AND RESULTS: A systematic review and meta-analysis was performed to search randomized clinical trials comparing abbreviated [i.e. very-short (1 month) or short (3 months)] with standard (≥6 months) DAPT in HBR patients without indication for oral anticoagulation. A total of 11 trials, including 9006 HBR patients, were included. Abbreviated DAPT reduced major or clinically relevant non-major bleeding [risk ratio (RR): 0.76, 95% confidence interval (CI): 0.61-0.94; I2 = 28%], major bleeding (RR: 0.80, 95% CI: 0.64-0.99, I2 = 0%), and cardiovascular mortality (RR: 0.79, 95% CI: 0.65-0.95, I2 = 0%) compared with standard DAPT. No difference in all-cause mortality, major adverse cardiovascular events, myocardial infarction, or stent thrombosis was observed. Results were consistent, irrespective of HBR definition and clinical presentation. CONCLUSION: In HBR patients undergoing PCI, a 1- or 3-month abbreviated DAPT regimen was associated with lower bleeding and cardiovascular mortality, without increasing ischaemic events, compared with a ≥6-month DAPT regimen. STUDY REGISTRATION: PROSPERO registration number CRD42021284004.
Discussion
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Cite This Study
Costa et al. (2022) conducted a meta-analysis in High bleeding risk after percutaneous coronary intervention (n=9,006). Abbreviated dual antiplatelet therapy (DAPT) vs. Standard DAPT (≥6 months) was evaluated on Major or clinically relevant non-major bleeding (RR 0.76, 95% CI 0.61-0.94). Abbreviated DAPT (1 or 3 months) reduced major or clinically relevant non-major bleeding (RR 0.76; 95% CI 0.61-0.94) compared with standard DAPT (≥6 months) in high bleeding risk patients post-PCI.