Ticagrelor monotherapy after ≤ 1-month DAPT vs continued DAPT in patients with acute coronary syndrome treated with percutaneous coronary intervention: A systematic review and meta-analysis of randomized controlled trials

• In patients with ACS within ≤ 1 month of DAPT post-PCI, ticagrelor monotherapy can reduce the risk of bleeding complications without raising the number of mortality and ischemic events. • Single antiplatelet therapy with ticagrelor was associated with a significant decrease of both all and major bleeding. • There was no significant difference between the groups regarding mortality, MI, stroke, TRV and stent thrombosis outcomes. Current guidelines recommend at least 12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). However, DAPT prolonged use may increase the risk of bleeding complications. Therefore, we aimed to perform a meta-analysis to assess whether ticagrelor monotherapy after ≤1 month of DAPT improves clinical outcomes compared with continued DATP in acute coronary syndrome (ACS) patients post-PCI. We systematically searched PubMed, Embase and Cochrane databases for randomized controlled trials published up to August 2024. All-cause and cardiovascular death, overall and major bleeding events, myocardial infarction (MI), stroke, target vessel revascularization (TVR) and stent thrombosis within 1–2 years post-procedure were evaluated. Statistical analysis was performed using Review Manager 5.1.7. Three studies and 13,737 patients were included, of whom 6861 (49.95 %) received ticagrelor alone. When compared with DAPT, ticagrelor monotherapy significantly reduced the risk of overall (2.0 % vs 4.5 %; RR 0.44; 95 % Cl 0.33–0,59; p < 0.00001) and major (1.4 % vs 2.5 %; RR 0.49; 95 % Cl 0.29–0.83; p = 0.04) bleeding events. Both antiplatelet regimens had similar rates of mortality, MI, stroke, TVR or stent thrombosis. This meta-analysis suggests that ticagrelor alone after ≤1 month of DAPT post-PCI in ACS patients reduces bleeding complications without increasing major adverse events compared with traditional DAPT for 12 months.