Key result
Short-term DAPT followed by ticagrelor monotherapy cuts major bleeding ~50% vs 12-month DAPT.
Why the study?
One-year DAPT after ACS in patients undergoing PCI with DES is standard of care but is associated with a higher incidence of bleeding events.
Does ticagrelor-based short-term DAPT followed by ticagrelor monotherapy reduce bleeding, NACCE, and mortality compared to 12-month DAPT in patients with ACS undergoing PCI with DES?
Meta-Analysis (n=21,407)
Does ticagrelor-based short-term DAPT followed by ticagrelor monotherapy reduce bleeding, NACCE, and mortality compared to 12-month DAPT in patients with ACS undergoing PCI with DES?
Relative Risk: 0.5 (95% CI 0.38–0.66)
p-value: p=< 0.01
In patients with ACS undergoing PCI with DES, short-term DAPT followed by ticagrelor monotherapy significantly reduces bleeding, NACCE, and all-cause mortality without increasing ischemic events compared to standard 12-month DAPT.
Supports ticagrelor de-escalation after short DAPT in ACS-PCI to cut bleeding; extends pooled RCT evidence on ischemic safety.
BACKGROUND: Dual antiplatelet therapy (DAPT) for 1 year after acute coronary syndrome (ACS) in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is the standard of care. However, it is associated with a higher incidence of bleeding events. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the safety and efficacy of short-term DAPT. AIMS: This study aimed to assess the relative risk of major and minor bleeding, net adverse clinical and cerebral events (NACCE), and all-cause mortality in patients with ACS undergoing PCI with DES, comparing ticagrelor-based short-term DAPT (≤ 3 months) followed by ticagrelor monotherapy for up to 12 months versus 12-month DAPT. The secondary endpoint evaluated the relative risk of complications, including myocardial infarction, stroke, stent thrombosis, repeat revascularization, and cardiovascular mortality. METHODS: A systematic search of PubMed, Scopus, and Cochrane Central was conducted for eligible RCTs. A subgroup analysis of ultrashort-term DAPT (≤ 1 month) followed by ticagrelor monotherapy for up to 12 months was also performed. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Five RCTs were included with a total of 21,407 patients. Short-term DAPT was associated with a significant reduction in major bleeding (RR 0.50; 95% CI 0.38-0.66; p < 0.01), minor bleeding (RR 0.53; 95% CI 0.35-0.80; p < 0.01), NACCE (RR 0.71; 95% CI 0.59-0.85; p < 0.01), and all-cause mortality (RR 0.78; 95% CI 0.62-0.98; p =0.04). CONCLUSIONS: Short-term DAPT followed by ticagrelor monotherapy up to 12 months was associated with a significant reduction in major and minor bleeding, NACCE, and all-cause mortality compared to 12-month DAPT. There were no significant differences in myocardial infarction, stroke, stent thrombosis, repeat revascularization, or cardiovascular mortality. Major bleeding and NACCE remained consistently reduced in the subgroup analysis.
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Guzman et al. (2025) conducted a meta-analysis in Acute coronary syndrome (ACS) undergoing PCI with DES (n=21,407). Ticagrelor-based short-term DAPT (≤ 3 months) followed by ticagrelor monotherapy vs. 12-month DAPT was evaluated on Major bleeding (RR 0.50, 95% CI 0.38-0.66, p=< 0.01). Ticagrelor-based short-term DAPT followed by ticagrelor monotherapy significantly reduced major bleeding (RR 0.50; 95% CI 0.38-0.66; p<0.01) compared to 12-month DAPT.
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